*~ ~'W:fc,. t^zytip UCICCM LIBK CALIFORNIA COLLEGE OF MEDICINE - to- SPARE HOURS" 1 JOHN BROWN, M.D. LL. D., ETC. ' ' Cefagotage de tant si diver ses pieces, sefaict en cette condition : qve je tfy mets la main, q-ue lors qu'une trap lascJte oysifvett me presses' MICHEL DK MONTAIGNB THIRD SERIES LOCKE AND SYDENHAM AND OTHER PAPERS Fourth Edition. BOSTON HOUGHTON, MIFFLIN AND COMPANY New York: 11 East Seventeenth Street (Cfce fiiters'iDe Press, 1884 I IZ * The Riverside Press, Cambridge : Stereotyped and Printed by H. O. Houghton & Co. " Knowledge and Wisdom, far from being one, Have ofttimes no connection. Knowledge dwells In heads replete with thoughts of other men ; Wisdom in minds attentive to their own. Knowledge is proud, that he has learnt so much ; Wisdom is humble, that he knows no more" COWPBR. VERAX, CAP AX SAG AX. PERSPICAX EFFICAX. TENAX. NOTE. THE present volume consists of a re-issue of the more purely professional papers published in 1866, to which I have added a few words on Dr. John Scott, Mr. Syme, and Sir Robert Christison. They are addressed more to myself than to anyone else. With some true things, and not unimportant, there are some rash and jejune ones ; but though recognizing fully the immense enlargement of our means of knowledge in these latter years, I would put in as strong a word as ever for the cultivation and concentration of the unassisted senses. Microscopes, sphygmographs, etc., are good, but don't let us neglect the drawing out into full power, by the keen and intelligent use of them, those eyes which we can always carry with us. It is this aKpt&eia, of the wise and subtle Greek, this ac- curacy (ad and euro) of the stout Roman, that is the eye of the physician and its memory, and it depends greatly on vivid attention in the act of seeing ; -as Dr. Chalmers said, there is a looking as well as a seeing. " I 've lost my spectacles," said good, easy Lord Cuninghame, as he was mooning about Brougham Hall in search of them, when on a visit to his vehement old friend, its Lord, whose mind was always in full spate. "Where did you lay them?" said Brougham. " I forget." "Forget! you should never forget ; nobody should forget. I never forget. You should attend ; I always do. 7 observed where you laid your spec- tacles ; there they are ! ' ' The onlv other thino-s I would now mention are, 1st, The NOTE. cramming system of Examinations Surely this mattcr : which is becoming an enormous nuisance and mischief and oppression to examiners as well as examinees, has reached that proverbial point when things begin to mend. Let some strong-brained, wide-knowledged, and merciful man find out the how to mend. 2d, I am more convinced than ever of the futility, and worse of the Licensing system, and think, with Adam Smith, that a niediciner should be as free to exercise his gifts as an architect or a mole-catcher. The Public has its own shrewd way of knowing who should build its house or catch its moles, and it may quite safely be left to take the same line in choosing its doctor. Lawyers, of course, are different, as they have to do with the State with the law of the land. J. B. 23 RUTLAND STREET, April 12, 1882. In order to render this collection of Dr. Brown's papers complete, the American publishers have added to this vol- ume the contents beginning with Miss Stirling Graham, of Duntrune. CONTENTS. PAOH INTRODUCTION ..19 LOCKE AND STDENHAM , 39 DR. ANDREW COMBE ........ 119 PH. HENRY MARSHALL AND MILITARY HYGIENE . 145 ART AND SCIENCE 193 OUR GIDEON GRAYS 207 DR. ANDREW BROWN AND SYDENHAM . f 221 FREE COMPETITION IN MEDICINE 235 EDWARD FORBES 241 DR. ADAMS OF BANCHORY 251 EXCURSUS ETHICUS 261 DR. JOHN SCOTT AND HIS SON. MR. SYME. SIR ROB- ERT CHRISTISON, BART 283 Dr. John Scott 285 Mr. Syme 289 Sir Robert Christison 300 Miss STIRLING GRAHAM OF DUNTRUNE .... 305 Sm E. LANDSEER'S PICTURE " THERE 'a LIFE IN THE OLD DOG YET," ETC., ETC. . . . . . 313 Halle's Recital 319 Biggar and the House of Fleming .... 328 "Giein' himseP a fleg" 329 Biggar as a Medical School .... 330 Robert Forsyth, Advocate 332 Mary Youston and Professional Ethics . . 334 " Langleathers " 335 Sin HENRY RAEBURN . 345 SOMETHING ABOUT A WELL . 369 PREFACE TO EDITION OF 1866. HESE occasional Papers appeared, with a few exceptions, in the early editions of HOR^E STJBSECIV-E, and were afterwards excluded as being too professional for the general reader. They have been often inquired for since, and are now re- printed with some fear that they may be found a sort of compromise of flesh and fowl, like the duck-billed Platypus neither one thing nor the other not med- ical enough for the doctors, and too medical for their patients. If they are of any use, it will be in confirming in the old and impressing on the young practitioners of the art of healing, the importance of knowledge at first hand ; of proving all things, and holding fast only that which is good : of travelling through life and through its cam- paigns, as far as can be, like Caesar relictis impedi- mentis neither burdened overmuch with mere word- knowledge, nor led captive by tradition and routine, nor demoralized by the pestilent lusts of novelty, notoriety, or lucre. This is one great difficulty of modern times ; the choosing not only what to know, but what to trust ; what not to know, and what to forget. Often when I see some of our modern Admirable Crichtons leaving their university, armed cap-a-pie, and taking the road, 10 PREFACE. where they are sure to meet with lions of all sorts, I think of King Jamie in his full armor " Naebody claur meddle wi' me, and," with a helpless grin, " I daur meddle wi' naebody." Much of this excess of the ma- terial of knowledge is the glory of our age, but much of it likewise goes to its hindrance and its shame, and forms the great difficulty with medical education. Every man ought to consider all his lecture-room knowledge as only so much outside of himself, which he must, if it is to do him any good, take in moderately, silently, selectly ; and by his own gastric juice and chylopoietics, turn, as he best can, in succum et sanguinem. The muscle and the cin- eritious matter, the sense and the power, will follow as matters of course. And every man. who is in earnest, who looks at nat- ure and his own proper work with his own eyes, goes on through life demolishing as well as building up what he has been taught, and what he teaches himself. He must make a body of medicine for himself, slowly, stead- ily, and with a single eye to the truth. He must not on every emergency run off to his Cyclopaedias, or, still worse, to his Manuals. For in physic, as in other things, men are apt to like ready-made knowledge ; which is generally as bad as ready-made shoes, or a second-hand coat. Our ordinary senses, our judgment and our law of duty, must make up the prime means of mastering and prosecuting with honor and success the medical, or in- deed any other profession founded upon the common wants of mankind. Microscopes, pleximeters, the nice tests of a delicate chemistry, and all the transcendental apparatus of modern refinement, must always be more for the few than for the many. Therefore it is that I would PREFACE. 11 insist more and more on immediate, exact, intense ob- servation and individual judgment, as the mainstays of practical medicine. From the strenuous, life-long, truth- loving exercise of these, let no amount of science, how- ever exquisite, decoy the student ; and let him who has them not greatly long after, as he will not greatly miss, these higher graces of the profession. What will make a valuable physician or surgeon now, and enable him when he dies to bequeath some good thing to his fellow- men, must in the main be the same as that which made Hippocrates and Sydenham, Baillie and Gregory, what we glory and rejoice to think they were. Therefore, my young friend, trust neither too much to others, nor too much to yourself ; but trust every- thing to ascertained truth to principles ; and as chemists can do nothing without a perfect balance, so see to it that your balance, that weighing faculty which God has given you, is kept true in a state, as Locke would say, of " absolute indifferency," turning only to the touch of honest weight. See that dust does not gather on its agate plate and studs, clogging its free edge. See that no one loads it, that you don't load it yourself, for we are all apt to believe that which we desire, and put down its results, as on soul and conscience, at all hazards letting it tell the truth, the whole truth, and nothing but the truth. One can fancy the care with which such men as New- ton, Bishop Butler, Dr. "Wollaston, or our own Faraday, would keep their mental balance in trim, in what a sacred and inmost place, away from all " winds of doctrine," all self-deceit and " cunning craftiness," all rust, all damp, all soiling touch, all disturbing influences, acting as truly as anything either of the Oertlings, or 12 PREFACE. Staudinger, or the exquisite Bianchi could turn out, 1 turning sweetly and at once, as theirs do, for big weights with the yj^th, and with small with the s-^jjth of a grain. And to keep up our joke, we need not be always pondering ; we should use what the chemists call the arrestment, by which the balance is relieved and rests. We will weigh and judge all the better that we are not always at it ; we may with advantage take a turn at rumination, contemplation, and meditation, all differ- ent and all restful, as well as useful ; and don't let us out of idleness or super-consciousness take to everlasting weighing of ourselves. As far as you can, trust no other man's scales, or weights, or eyes, when you can use your own, and let us in a general way look with both our eyes. It was a great relief to reflecting mankind, when the stereoscope showed us the use of having two eyes, and that human nature had not been all its days carrying number two as a fox-hunter does his extra horse-shoe, in case of losing number one. "We see solidity by means of our two eyes ; we see, so to speak, on both sides of a body ; and we find, what indeed was known before, that the ultimate image, or rather the idea of external objects, is a compromise of two images, a tertium quid, which has no existence but in the brain, somewhere, I suppose, in the optic Chiasma. Now there is such a thing as stereoscopic thinking, the viewing subjects as well as objects with our two eyes. Some men of intense nature shut one of the eyes of the mind, as a sportsman does his actual eye when he aims at his game, because then there is a straight line 1 A friend says, "put in Liebrich and Jung, and thai a good bal- ance should turn with _i 5 th O f a Troy grain " ! PREFACE. 13 between Ais eye and Ais object; but for the general pur- pose of understanding and mastering the true bulk and projection, the whereat/outs and relations of a subject, it is well to look with both eyes ; and so it comes to pass that the focus of one man's mental vision differs from that of another, probably in some respects from that of all others, and hence the allowance which we should make for other men when they fail to see not only things, but thoughts, exactly as we do. We will find, when we look through their stereoscope, we don't see their image as they do, it may be double, it may be distorted and blurred. I have long thought that upon the deepest things in man's nature those that bind him to duty, to God, and to eternity no man receives the light, no man sees " into the life of things," exactly as any other does, and that as each man of the millions of the race since time began has his own essence, that which makes him himself, and qua, that, distinct from all else, so ultimate truth, when it lies down to rest and be thankful on the optic Thalami of the soul, has in it a something incommunicable, unintelligible to all others. No two men out of ten thousand, gazing at a rainbow, see the same bow. They have each a glorious arch of their own, and while they agree as to what each says of it, still doubtless there is in each of those ten thousand internal glories within the veil, in the chamber of im- agery, some touch, some tint, which differentiates it from all the rest. But to return : look with both eyes, and think the truth as you would speak and act it. It is the rarer virtue, I suspect. When the English nobility were overwhelming Ca- nova with commissions, and were ignorant of the exist- ence of their own Flaxman, the generous Italian rebuked 14 PREFACE. them by saying, " You English see with our and there is much of this sort of seeing in medicine jn well as in art and fashion. I end with the weighty words of one who I rejoice * still a living honor to our art ; a man uniting much ol the best of Locke and Sydenham with more of himselt and whose small volumes contain the very medulla m* dicince ; a man who has the courage to say, " I wa wrong ; " "I do not know ; " and " I shall wait and watch." " I make bold to tell you my conviction, that during the last thirty-six years the practice of medicine has upon the whole " (taking in the entire profession) " gone backwards, and that year after year it is still going back- wards. Doubtless in the mean time there has been 9 vast increase of physiological and pathological knowl- edge ; but that knowledge has not been brought to bea", in anything like the degree it might and ought to have been, upon the practice of medicine ; and simply for this reason, that the mass of the profession has never been taught what the practice of medicine means. " Had the same office (the settling the kind and amount of professional education) been committed to Gregory, and Heberden, and Baillie, they would, I am persuaded, have made the indispensable subjects of educa- tion very few, and the lectures very few too. " They would have made the attendance upon the sick in hospitals a constant, systematic, serious affair. 1 As l We wish we saw more time, and more handiwork, more mind spent upon anatomy and surgery, especially clinical surgery. There is a great charm for the young in the visibility of surgical disease and practice, in knowledge at the finger-ends, and the principles and per- formance of a true surgery constitute one of the best disciplines for the office of the physician proper. PREFACE. 15 for the "ologies," they would have thrown them all overboard, or recommended them only to the study of those who had time enough, or capacity enough, to pur- sue them profitably." These are golden words ; put them in your scales, and read off and register their worth. You will observe that it is the practice, not the study it is the inner art, not the outer science of medicine which is here referred to as being retrograde. We ques- tion very much if there is as much skill, in its proper sense, now as then. There is to be sure the immense negative blessing of our deliverance from the polyphar- macy aud nimia diligenlia of our forefathers, and there- fore very likely more of the sick get well now than then. But this is not the point in question ; that is whether the men who practise medicine, taken in the slump, have the ability and practical nous that they had five- and-thirty years ago. Diagnosis has been greatly advanced by the external methods of auscultation, the microscope, chemical anal- ysis, etc. and there is (I sometimes begin to fear we must say was) a better understanding of and trust in the great restorative powers of nature. The recognition of blood poisons, and of many acute diseases, being in fact the burning out of long-slumbering mischief, the cleans- ing away of the perilous stuff manufactured within, or taken in from without, as seen in a fit of gout ; in all this we have gained more than we have lost (we always lose something), but is the practical power over disease commensurate with these enlargements ? is our sagacity up to our science ? The raw " prentice " lad whom Gideon Gray had sent up from Middlemas to the head of Caddon Water, to deliver the herd's wife, and who, finding her alone, and 16 PREFACE. sinking from uterine haemorrhage, and having got the huge flaccid deadly bag to contract once more, im- prisoned it in a wooden bicker or bowl, with a tight binder over it, leaving his hands free for other work, this rough and ready lad has probably more of the mak- ing of a village Abercrombie, than the pallid and accom- plished youth who is spending his holidays at the next farm, and who knows all for and against Dr. R. Lee's placental and cardiac claims, and is up to the newest freak of the Fallopian tubes and their jimbrice, or the very latest news from the ovisac and the corpora lutea. To be sure, there may be boys who can both know everything, and do the one thing that is needed, but the mental faculties, or capacities rather, that are cultivated, and come out strong in the cramming system, are not those on which we rely for safe, ready, and effectual action. We are now, in our plans of medical education, aim- ing too much at an impossible maximum of knowledge in all, meanwhile missing greatly that essential mini- mum in any, which, after all, is the one thing we want for making a serviceable staff of doctors for the com- munity. Sagacity, manual dexterity, cultivated and intelligent presence of mind, the tactus eruditus, a kind heart, and a conscience, these, if there at all, are always at hand, always inestimable ; and if wanting, " though I speak with the tongues of men and of angels, I am as sound- ing brass, or a tinkling cymbal ; and though I under- stand all mysteries, and all knowledge, I am nothing." I can profit my patient and myself nothing. In the words of Dr. Latham : * l Clinical Medicine, Lect. I. PREFACE. 17 " In our day there is little fear that students will be spoiled by the recommendation of their instructors to be content with a scanty knowledge, and trust to their own sagacity for the rest. They are not likely to suffer harm by having Sydenham held up as an example for imitation. The fear is of another kind (and it is well grounded), namely, that many men of the best abilities and good education will be deterred from prosecuting physic as a profession, in consequence of the necessity indiscriminately laid upon all for impossible attain- ments" And again : " Let us take care then what we are about, and be- ware how we change the character of the English prac- titioner of physic. He is sound and unpretending, and full of good sense. What he wants is a little more care- ful, and a somewhat larger instruction in what bears directly upon the practical part of his profession. Give it him (indeed we are giving it him), and he will be- come more trustworthy and more respected every day. But for all that is beyond this, we may recommend it, but we must not insist upon it ; we must leave it for each man to pursue according to his leisure, his opportuni- ties, and his capacity, and not exaggerate it into a matter of necessity for all. When too much is exacted, too little will be learned ; excess on the one hand nat- urally leads to defect on the other." 2 INTRODUCTION. 1 Y objects, in this volume of odds and ends, are, among others, I. To give my vote for going back to the old manly intellectual and literary culture of the days of Sydenham and Arbuthnot, Heberden and Gregory ; when a physician fed, enlarged, and quickened his entire nature ; when he lived in the world of letters as a free- holder, and reverenced the ancients, while, at the same time, he pushed on among his fellows, and lived in the present, believing that his profession and his patients need not suffer, though his horce subsecivtz were devoted occasionally to miscellaneous thinking and reading, and to a course of what is elsewhere called " fine confused feeding," or though, at his by-hours he be, as his Gaelic historian says of Hob Roy, a man " of incoherent trans- actions specially in general." For system is not al- ways method, much less progress. II. That the study in himself and others of the hu- man understanding, its modes and laws as objective real- ities, and his gaining that power over mental action in 1 This Introduction contains so mnch of the Preface to the First Edition as relates to the contents of this volume. The. remainder may be found in the Author's Preface prefixed to the first series of Spare Hours. 20 INTRODUCTION. himself and others, which alone comes from knowledge at first-hand, is one which every physician should not only begin in youth, but continue all his life long, and which hi fact all men of sense and origiual thought do make, though it may lie in their minds, as it were, un- formed and without a tongue. III. That physiology and the laws of health are the interpreters of disease and cure, over whose porch we may best inscribe hinc sanitas. That it is in watching Nature's methods of cure l in ourselves and in the lower animals, and in a firm faith in the self-regulative, re- cuperative powers of nature, that all our therapeutic in- tentions and- means must proceed, and that we should watch and obey this truly Divine voice and finger, with reverence and godly fear, as well as with diligence and worldly wisdom humbly standing by while He works, guiding, not stemming or withdrawing, His current, and acting as His ministers and helps. Not, however, that we should go about making every man, aud above all, every woman, his and her own and everybody else's doctor, by making them swallow a dose of science and physiology, falsely so called. There is much mischiev- ous nonsense talked and acted on, in this direction. The l " ' That there is no curing diseases by art, without first knowing how they are to be cured by nature,' was the observation of an an- cient physician of great eminence, who very early in my life superin- tended niy medical education, and by this axiom all my studies and practice have been regulated." Grant on Fevers, Loud. 1771. An admirable book, and to be read still, as its worth, like that of nature, never grows old, naturam non pati senium. We would advise every young physician who is in practice to read this unpretending and nov little-known book, especially the Introduction. Any "ancient physi cian," and the greater his eminence and his age the better, so that th^ eminence be real, who takes it up, will acknowledge that the author hai done what he said, made " this axiom " the rule, of his life and doctrine INTRODUCTION. 21 physiology to be taught in schools, and to our clients the public, should be the physiology of common sense, rather than that of dogmatic and minute science ; and should be of a kind, as it easily may be, which will de- ter from self-doctoring, while it guides in prevention and conduct ; and will make them understand enough of the fearful and wonderful machinery of life, to awe and warn, as well as to enlighten. Much of the strength and weakness of Homoeopathy lies in the paltry fallacy, that every mother, and every clergyman, and " loose woman," as a wise friend calls the restless public old maid, may know when to admin- ister aconite, arsenicum. and nux, to her child, his entire parish, or her " circle." Indeed here, as elsewhere, man's great difficulty is to strive to walk through life, and through thought and practice, in a straight line ; to keep in medio in that golden mean, which is our true centre of gravity, and which we lost in Eden. "We all tend like children, or the blind, the old, or the tipsy, to walk to one side, or wildly from one side to the other : one extreme breeds its opposite. Hydropathy sees and speaks some truth, but it is as in its sleep, or with one eye shut, and one leg lame ; its practice does good, much of its theory is sheer nonsense, and yet it is the theory that its masters and their constituents doat on. If all that is good in the Water-Care, and in Rubbing, and in Homeopathy, were winnowed from the false, the useless, and the worse, what an important and permanent addition would be made to our operative knowledge ! to our powers as healers ! and here it is, where I cannot help thinking that we have, as a profession, gone astray in our indiscriminate abuse of all these new practices and nostrums : they indicate, however coarsely and 22 INTRODUCTION. stupidly, some want in us. There is in them all some- thing good, and if we could draw to us, iustead of driv- ing away from us, those men whom we call, and in the main truly call, quacks, if we could absorb them with a difference, rejecting the ridiculous and mischievous much, and adopting and sanctioning the valuable little, we and the public would be all the better off. Why should not " the Faculty " have under their control and advice, and at their command, rubbers, and shampooers, and water men, and milk men, and grape men, and cudgelling men, as they have cuppers, and the like, in- stead of giving them the advantage of crying out " per- secution," and quoting the martyrs of science from Galileo downwards. IV. As my readers may find to their discontent, the natural, and, till we get into " an ampler aether and diviner air," the necessary difference between specula- tive science and practical art is iterated and reiterated with much persistency, and the necessity of estimating medicine more as the Art of healing than the Science of diseased action and appearances, 1 and its being more l When the modern scientific methods first burst on our medical world, and especially, when morbid anatomy in connection with phys- ical signs (as distinguished from purely vital symptoms, an incom- plete but convenient distinction), the stethoscope, microscope, etc., it, as a matter of course, became the rage to announce, with startling minuteness, what was the organic condition of the interior as if a watchmaker would spend most of his own time and his workmen's in debating on the beautiful ruins of his wheels, instead of teaching him- self and them to keep the totum quid clean and going, winding it up before it stopped. Renowned clinical professors would keep shiver- ing, terrified, it might be dying, patients sitting up while they ex- hibited their powers in auscultation and pleximetry, etc., the poor students, honest fellows, standing by all the while and supposing this to be their chief end ; and the same eager, admirable, and acute per former, after putting down everything in a book, might be seen mov INTRODUCTION. 23 teachable and better by example than by precept, in- sisted on as one of the most urgent wants of the time. But I must stick to this. Regard for, and reliance on a person, is not less necessary for a young learner than belief in a principle, or an abstract body of truth ; and here it is that we have given up the good of the old apprenticeship system, along with its evil. This will remedy, and is remedying itself. The abuse of huge classes of mere hearers of the law, under the Professor, ing on to the lecture-room, where he told the same youths what they would Jind on dissection, with more of minuteness than accuracy, deep- ening their j'oung wonder into awe, and begetting a rich emulation in all these arts of diagnosis, while he forgot to order anything for the cure or relief of the disease ! This actually happened in a Parisian hospital, and an Englishman, with his practical turn, said to the lively, clear-headed professor, " But what are you going to give him ? " " Oh ! " shrugging his shoulders, "I quite forgot about that ; " possibly little was needed, or could do good, but that little should have been the main thing, and not have been shrugged at. It is told of another of our Gallic brethren, that having discovered a specific for a skin disease, he pursued it with such keenness on the field of his patient's surface, that he perished just when it did. On going into the dead-house, our conqueror examined the surface of the subject with much interest, and some complacency not a vestige of disease or life, and turning on his heel, said, " II est mort gueri ! " Cured indeed ! with the disadvantage, single, but in one sense infinite, of the man being dead ; dead, with the advantage, general, but at best finite, of the scaly tetter being cured. In a word, let me say to my young medical friends, give more at- tention to steady common observation the old Hippocratic aicpi'/Jeia, exactness, literal accuracy, precision, niceness of sense ; what Syden- ham calls the natural history of disease. Symptoms are universally available; they are the voice of nature; signs, by which I mean more artificial and refined means of scrutiny the stethoscope, the micro- scope, etc. are not always within the power of every man, and, with all their help, are additions, not substitutes. Besides, the best natural and unassisted observer the man bred in the constant practice of keen discriminating insight is the best man for all instrumental niceties; and above all. the faculty and habit of gathering together the entire 2-i INTRODUCTION. has gone, I hope, to its utmost, and we may now look for the system breaking up into small bands of doers acting under the Master, rather than multitudes of mere listeners, and not unoften sleepers. Connected with this, I cannot help alluding to the crying and glaring sin of publicity, in medicine, as in- deed in everything else. Every great epoch brings with it its own peculiar curse as well as blessing, and in religion, in medicine, in everything, even the most symptoms, and selecting what of these are capital and special ; and trusting in medicine as a tentative art, which, eren at its utmost con- ceivable perfection, has always to do with variable quantities, and is conjectural and helpful more than positive and all-sufficient, content with probabilities, with that measure of uncertainty which experience teaches us attaches to even-thing human and conditioned. Here are the candid and wise words of Professor Syme: "In performing an opera- tion upon the living body, we are not in the condition of a blacksmith or carpenter, who understands precisely the qualities of the materials upon which he works, and can depend on their being always the same. The varieties of human constitution must always expose our proceed- ings to a degree of uncertainty, and render even the slightest liberties possibly productive of the most serious consequences; so that the ex- traction of a tooth, the opening of a vein, or the removal of a small tumor, has been known to prove fatal. Then it must be admitted that the most experienced, careful, and skilful operator may commit mistakes; and I am sure that there is no one of the gentlemen present who can look back on his practice and say he has never been guilty of an error." This is the main haunt and region of his craft. This it is that makes the rational practitioner. Here again, as in religion, men now-a-days are in search of a sort of fixed point, a kind of demonstra- tion and an amount of certainty which is plainly not intended; for from the highest to the lowest of these compound human knowledges, "probability," as the great and modest Bishop Butler says, "is the rule of life ; " it suits us best, and keeps down our always budding self-conceit and self-confidence. Symptoms are the body's mother- tongue; signs arc in a foreign language; and there is an enticing ab- sorbing something about them, which, unless feared and understood, I have sometimes found standing in the way of the others, which are the staple of our indications, always at hand, and open to all. INTRODUCTION. 25 sacred and private, this sin of publicity now-a-days most injuriously prevails. Every one talks of everything and everybody, and at all sorts of times, forgetting that the greater and the better the inner part, of a man, is, and should be private much of it more than private. Public piety, for instance, which means too much the looking after the piety of others and proclaiming our own the Pharisee, when he goes up to the temple to pray, looking round arid criticising his neighbor the pub- lican, who does not so much as lift up his eyes even to heaven the watching and speculating on, and judging (scarcely ever with mercy or truth) the intimate and unspeakable relations of our fellow-creatures to their infinite Father, is often not coexistent with the inward life of God in the soul of man, with that personal state, which alone deserves the word piety. So also in medicine, every one is for ever looking after, and talking of everybody else's health, and advis- ing and prescribing either his or her doctor or drug, and that wholesome modesty and shamefacedness, which I regret to say is now old-fashioned, is vanishing like other things, and is being put off, as if modesty were a mode, or dress, rather than a condition and essence. Besides the bad moral habit this engenders, it breaks up what is now too rare, the old feeling of a family doctor there are now as few old household doctors as servants the familiar, kindly, welcome face, which has presided through generations at births and deaths ; the friend who bears about, and keeps sacred, deadly secrets which must be laid silent in the grave, and who knows the kind of stuff his stock is made of, their " constitutions," all this sort of thing is greatly gone, especially in large cities, and much from this love of change, of talk, of having 26 INTRODUCTION. everything explained, 1 or at least named, especially if it be in Latin, or running from one " charming " specialist to another ; of doing a little privately 2 and dishonestly 1 Dr. Cullen's words are weighty : " Neither the aeutest genius nor the soundest judgment will avail in judging of a particular science, ill regard to which they have not been exercised. / have been olliyed to please my patients sometimes with reasons, and I hare found (hat any will pass, even with able divines and acute lawyers; the same will past with the husbands as with the wives." 2 I may seem too hard on the female doctors, but I am not half so bard or so bitter as the old Guy (or, as his accomplished and best edi- tor, M. Reveille'-Parise, insists on calling him, Gui) Patin. I have af- terwards called Dr. J. H. Davidson our Scottish Guy Patin; and any one who knew that remarkable man, and knows the Letters of the witty and learned enemy of Mazarin, of antimony, and of quacks, will acknowledge the likeness. Patin, speaking of a certain Made- moiselle de Label, who had interfered with his treatment, says: " C'est un sot animal qu'une femme qui se niele de notre metier." But the pas- sage is so clever and so characteristic of the man, that I give it in full : "Noel Falconet a port4 lui-meme la lettre a Mademoiselle de Label; son fils est encore malade. Elle ne m'a point voulu croire ; et au lieu de se servir de mes remedes, elle lui a donne 1 des siens, quo aynito re~ cessi. C'est un sot animal qu'une femme qui se mele de notre metier: cela n'appartient qu'a ceux qui out un haut-de-chausses et la tt-te bien faite. J'avois fait, saigner et purger ce malade; il se portoit mieux; elle me dit ensuite que mes purgatifs lui avoient fait mal, et qu'elle le purgeoit de ses petits remedes, dout elle se servoit a Lyon autrefois. Quand j'eus reconnu par ces paroles qu'elle ne faisait pas grand e'tat de mes ordonnances, je la qurttai la et ai pratique 1 le pre'cepte, sinite mortuos sepelire mortuos. Peut-etre pourtant qu'il en re'chappera, ce }ue je souhaite de tout mon coeur ; car s'il mouroit, elle diroit que ce fceroit moi qui 1'aurois tue 1 . Elle a temoigne" a Noel Falconet qu'elle avoit regret de m'avoir faclie 1 , qu'elle m'enverroit de 1'argent (je n'ea ai jamais pris d'eux). Feu M. Hautin disoit: Per monachos et mo- nachas, cognatos et cognatas, vicinos et ricinas medicus nonfacit res suas. Ce u'est pas ii faire a, une femme de pratiquer la methode de Ga- lien, res est sublimioris intelligent ice ; il faut avoir 1'esprit plus fort. Mulier est animal dimidiati intellectus; il faut qu'elles filent leur que- nouille, ou an moins, comnie dit Saint Paul, contineant se in silentio. Feu M. de Villeroi, le grand secretaire d'Etat, qui avoit une mauvaise femme (il n'e"toit pas tout seul, et la race n'en e?* oas morte), disoit INTRODUCTION. 27 K) one's self or the children with the globules ; of going to see some notorious great man without telling or tak- ing with them their old family friend, merely, as they say, " to satisfy their mind," and of course, ending in leaving, and affronting, and injuring the wise and good man. I don't say these evils are new, I only say they are large and active, and are fast killing their opposite virtues. Many a miserable and tragic story might be told of mothers, whose remorse will end only when they themselves lie beside some dead and beloved child, whom they, without thinking, without telling the father, without " meaning anything," have, from some such grave folly, sent to the better country, leaving them- selves desolate and convicted. Publicity, itching ears, want of reverence for the unknown, want of trust in goodness, want of what we call faith, want of gratitude and fair dealing, on the part of the public ; and on the part of the profession, cupidity, curiosity, restlessness, ambition, false trust in self and in science, the lust and haste to be rich, and to be thought knowing and om- niscient, want of breeding and good sense, of common honesty and honor, these are the occasions and results of this state of things. I am not, however, a pessimist, I am, I trust, a rational optimist, or at least a meliorist. That as a race, and as a profession, we are gaining, I don't doubt ; to disbelieve this, is to distrust the Supreme Governor, and to miss the lesson of the time, which is, in the main, qu'en latin une femme dtoit mulier, c'est-a-dire mule hitr, mule demain, mule tottjoura." 1 1 Salomon a dit quelqiio part : Tl n'y a jtax de malice au-dessus rle celle d'uneftmme. Krasine mit ac&t5 cette reflexion: Vous observerez qiSil n'y wait pas encore de moines. (II. p.) 2S INTRODUCTION. enlargement and progress. But we should all do our best to keep what of the old is good, and detect, and moderate, and control, and remove what of the new is evil. In saying this, I would speak as much to myself as to my neighbors. It is in vain, that yvwdi creauToy (know thyself) is for ever descending afresh and silently from heaven like dew ; all this in vain, if eywye yiyvtoo-Kta (I myself know, I am as a god, what do I not know !) is for ever speaking to us from the ground and from ourselves. Let me acknowledge and here the principle or habit of publicity ha's its genuine scope and power the immense good that is in our time doing by carrying Hygienic reform into the army, the factory, and the nursery down rivers and across fields. I see in all these great good ; but I cannot help also seeing those private personal dangers I have spoken of, and the masses cannot long go on improving if the individuals deteriorate. There is one subject which may seem an odd one for a miscellaneous book like this, but one in which I have long felt a deep and deepening concern. To be brief and plain, I refer to man-midwifery, in all its relations, professional, social, statistical, and moral. I have no space now to go into these fulfy. I may, if some one better able does not speak out, on some future occasion try to make it plain from reason and experience, that the management by accoucheurs, as they are called, of natural labor, and the separation of this department of the human economy from the general profession, has been a greater evil than a good ; and that we have little to thank the Grand Monarque for, in this as in many other things, when, to conceal the shame of the gentle INTRODUCTION. 29 La Valliere, he sent for M. Chison instead of the cus- -omary sage-femme. Any husband or wife, any father or mother, who will look at the matter plainly, may see what an inlet there is here to possible mischief, to certain unseemliness, and to worse. Nature tells us with her own voice what is fitting in these cases ; and nothing but the omnipotence of custom, or the urgent cry of peril, terror, and agony, what Luther calls miserrima miseria, would make her ask for the presence of a man on such an occasion, when she hides herself, and is in travail. And as in all such cases, the evil reacts on the men as a special class, and on the profession itself. It is not of grave moral delinquencies I speak, and the higher crimes in this region ; it is of affront to Nature, and of the revenge which she always takes on both par- ties, who actively or passively disobey her. Some of my best and most valued friends are honored members of this branch ; but I believe all the real good they can do, and the real evils they can prevent in these cases, would be attained, if instead of attending to their own lu- dicrous loss of time, health, sleep, and temper, some 200 cases of delivery every year, the immense majority ^f which are natural, and require no interference, but have nevertheless wasted not a little of their life, their patience, and their understanding they had, as I would always have them to do, and as any well-educated reso- ..ute doctor of medicine ought to be able to do, confined themselves to giving their advice and assistance to the midwife when she needed it. I know much that may be said against this igno- rance of midwives ; dreadful effects of this, etc. ; but to all this I answer, Take pains to educate carefully, and to 30 INTRODUCTION. pay well, and treat well these women, and you may safely regulate ulterior means by the ordinary general laws of surgical and medical therapeutics. Why should not " Peg Tamson, Jean Simsou, and Alison Jaup," 1 be sufficiently educated and paid to enable them to conduct victoriously the normal obstetrical business of " Middle- mas " and its region, leaving to " Gideon Gray " the ab- normal, with time to cultivate his mind and his garden, or even a bit of farm, and to live and trot less hard than he is at present obliged to do? Thus, instead of a man in general practice, and a man, it may be, with an area of forty miles for his beat, sitting for hours at the bed- side of a healthy woman, his other patients meanwhile doing the best or the worst they can, and it may be, as not unfrequently happens, two or more labors going on at once ; and instead of a timid, ignorant, trusting woman to whom her Maker has given enough of " sorrow," and of whom Shakespeare's Constance is the type, when she says, " I am sick, and capable of fears ; I am full of fears, subject to fears ; I am a woman, and therefore naturally born to fears " being in this hour of her agony and apprehension subjected to the artificial misery of fearing the doctor may be too late, she might have the absolute security and womanly hand and heart of one of her own sex. This subject might be argued upon statistical grounds, and others ; but I peril it chiefly on the whole system being unnatural. Therefore, for the sake of those who have borne and carried us, and whom we bind ourselves to love and cherish, to comfort and honor, and who suffer so much that is inevitable from the primal curse, for its own sake, let the profession look into this entire sub- 1 Vide Sir Walter Scott's Surgeon's Daughter. INTRODUCTION. 31 ject in all its bearings, honestly, fearlessly, and at once. Child-bearing is a process of health ; the exceptions are ew indeed, and would, I believe, be fewer if we doctors would let well alone. One or two other things, and I am done. I could have wished to have done better justice to that noble class of men our country practitioners, who dare not B^eak out for themselves. They are underpaid often tot paid at all underrated, and treated in a way that the commonest of their patients would be ashamed to treat his cobbler. How is this to be mended? It is mending itself by the natural law of starvation, and de- scent per deliquium. Generally speaking, our small towns had three times too many doctors, and, therefore, each of their Gideon Grays had two thirds too little to live on ; and being in this state of chronic hunger they were in a state of chronic anger at each other not less steady, with occasional seizures more active and acute ; they had recourse to all sorts of shifts and meannesses to keep soul and body together for themselves and their horse, whilst they were acting with a devotion, and, gen- erally speaking, with an intelligence and practical be- neficence, such as I know, and I know them well, nothing to match. The gentry are in this, as in many country things, greatly to blame. They should cherish, and reward, and associate with those men who are in all essentials their equals, and from whom they would gain as much as they give ; but this will right itself as civil- ized mankind return, as they are doing, to the country, and our little towns will thrive now that lands change, lairds get richer, and dread the city as they should. The profession in large towns might do much for their friends who can do so little for themselves. I am a vol- 32 INTRODUCTION. untary in religion, and would have all State churches abolished ; but I have often thought that if there was a class that ought to be helped by the State, it is the coun- try practitioners in wild districts ; or what would be bet- ter, by the voluntary association of those in the district who have means in this case creeds would not be troublesome. However, I am not backing this scheme. I would leave all these things to the natural laws of supply and demand, with the exercise of common hon- esty, honor, and feeling, in this, as in other things. The taking the wind out of the rampant and abomi nable quackeries and patent medicines, by the State with- drawing altogether the protection and sanction of its stamp, its practical encouragement (very practical), and giving up their large gains from this polluted and wicked source, would, I am sure, be a national benefit. Quack- ery, and the love of being quacked, are in human nature as weeds are in our fields ; but they may be fostered into frightful luxuriance, in the dark and rich soil of our people, and not the less that Her Majesty's super- scription is on the bottle or pot. I would beg the attention of my elder brethren to what I have said on Medical Reform and the doctrine of free competition. I feel every day more and more its importance and its truth. I rejoice many ways at the passing of the new Medical Bill, and the leaving so much to the discretion of the Council ; it is curiously enough almost verbatim, and altogether in spirit, the measure Professor Syme has been for many years advo- cating through good and through bad report, with his characteristic vigor and plainness. Holloway's Oint- ment, or Parr's Pills, or any such monstra horrenda, at- tain their gigantic proportions and power of doing rnis- INTRODUCTION. 33 chief, greatly by their having Governmental sanction and protection. Men of capital are thus encouraged to go into them, and to spend thousands a year in adver- tisements, and newspaper proprietors degrade themselves into agents for their sale. One can easily see how harmless, if all this were swept away, the hundred Hol- loways, who would rise up and speedily kill nobody but each other, would become, instead of one huge inap- proachable monopolist ; this is the way to put down quackery, by ceasing to hold it up. It is a disgrace to our nation to draw, as it does, hundreds of thousands a year from these wages of iniquity. 23 RUTLAND STREET, October 30, 1858. POST-PREFACE. f|WO hitherto unpublished letters of Locke and Sydenham, I had the good fortune to find in the British Museum, that among the best and chiefest of our national glories, where, strange to say, I found myself for the first time the other day. Not to my sorrow, for I am not by any means sure that it is not an advantage to be not young before seeing and feeling some things. A man at all capable of ideal exquisiteness has a keener because a deeper sense of the beauty of the Clytie of the awfulness of those deep- bosomed Fates, resting in each other's laps, "careless diffused " after,- than before he finds himself "Nel mezzo del caramin di nostra vita." Time and suffering, and self-knowledge, the mystery, the vanity and the misery of life, quicken and exalt our sense and relish of that more ample greatness, that more exact goodness, that sense of God, 1 which the contem- 1 In a certain and large sense Malebranche is right. We see every- thing in God, as well as God in everj-thing; all beauty of thought, passion, affection, form, sound, color, and touch, whatever stirs our mortal and immortal frame, not only comes from, but is centred in God, in his unspeakable perfections. This we believe to be not only .norally, but in its widest sense, philosophically true, as the white light ravs itself out into the prismatic colors, making our world what it is as if all that we behold were the spectrum of the unseen Eternal. In that thinnest but not least great of his works, Mr. Euskin's sec- INTRODUCTION. 35 plation of Nature and Art at their utmost of power and beauty ought always to awaken and fill. It is the clear shining after the rain. Pain of body or of mind, by a double-edged, but in the main, merciful law of God and of our nature, quickens and exalts other senses besides that of itself. Well is it that it does. Sweetness is sweeter than before to him who knows what bitterness has been, and remembered sweetness too. The disloca- tion of the real and the ideal the harsh shock of which comes on most men before forty, and OB most women sooner, when the two lines run on together sometimes diverging frightfully, for the most part from their own fault but never meet, makes him- look out all the more keenly for the points where he can safely shunt himself; it is a secret worth knowing and acting upon, and then you can go and come as you list. This is our garden, every one's garden of the Hesperides, into which if we only know the right airt and door it is small and lowly, and made for children, or those who can stoop and make themselves so for the nonce we may at any time enter, and find sunshine and shadows, and soft airs and clear waters, and pluck the golden apples from the laden boughs. And though the Dragon is there, he is our own Dragon ; and it adds to the glory of the new-born day, and gives a strange flavor of peril and volume of Modern Painters, there may be found the best un- folding I know of the doctrine that all sublimity and all beauty is typical of the attributes of God. I give his divisions, which are them- selves eloquent: Typical Beauty: first, of Infinity, or the type of Divine Incomprehensibility ; second, of Unity, or the type of Divine Comprehensiveness ; third, of Repose, or the type of Divine Perma- nence ; fourth, of Symmetry, or the type of Divine Justice ; fifth, of Purity, or the type of Divine Energy ; lastly, of Moderation, or the type of Government by Law. 36 INTRODUCTION. to its innocent brightness, when we see on the horizon that he is up too, and watching, lying sinuous and im- mense all across the Delectable Mountains, witli his chin on his paw on the biggest hill, and the sunlight touch- ing up his scales with gold and purple. This is our Paradise at hand next door, next room, you are in it by thinking of it, it comes into you if you open your door, guarded only to those who have been cast out of it, and under whose flaming sword the small people may creep, and the only serpent in which each must himself bring, or be ; and then, best of all if you are in the right garden this ideal fruit is among the best of whets and tonics, and strengthened for the hard every-day work, and still harder night-and-day suf- fering of that real world, which is not much of a garden, but rather a field and a road, with graves as milestones. This in its own place, wisely, temperately enjoyed, ena- bles many a man and many a woman to lighten some- what " The heavy and the weary weight Of all this unintelligible world," > and go on their way, if not rejoicing, at least patient and thankful ; and, like the heroic apostle, sorrowful, yet always rejoicing. I am therefore less sorry than glad that I was as old as Cortez when he first gazed on the Pacific, before I saw the Pyrenees, and the Venus of Melos, and Ti- tian's Entombment, and Paul Veronese's Cain, with his wife and child, and the Rhine under a midnight thunder- storm at Coblentz, and the Turners at Farnley Hall; and it pleases me more than the reverse, to think that I have the Alps, and Venice, and Memphis, and old Thebes, yet to see, and a play or two of Shakespeare's INTRODUCTION. 37 to read, and the Mangostein to pluck and eat, and Niag- ara to hear. But one thing I am glad to have seen, and not to have seen it till I did, and that is the Panizzi Reading Room in the British Museum, where you may any day see three hundred, feeding silently like one, browsing each as if alone in his own chosen pasture. There can never be any nobler or more fitting monument to that great man, who is the informing spirit, the soul and mo- tive power of that amazing concentration and record of human conquest and progress, whose prodigious brain and will has reared "This dome of thought, this palace of the soul," and whose formidable understanding and inevitable vis- age fronts you in Marochetti's marble as you enter a head of the genuine old Roman build, an unmistakable rerum dominus. The letter now printed at page 121 was written two months later than th'e one quoted at page 47, and on the same subject. I like this letter exceedingly, every word of it, and wish I could ask the delightful and omniscient Notes and Queries who " Tom Bagnall " was, and what is the joke of " the thrushes and fieldfares," and the " hey trony nony." The solemn and prolonged, but genial banter about " t' other condition " is very pleasant and characteristic ; the desipience of such a man as John Locke is never out of place, and is as sweet to listen to now as it could have been to his thoughtful and affec- tionate self to indulge in, a hundred and eighty years, and more ago. 38 INTRODUCTION. In the same MS. volume in which I found this letter is a case-book of Locke's, in his own neat hand, written in Latin (often slovenly and doggish enough), and which shows, if there were any further need, that he was in active practice in 1667. The title in the Museum vol- ume is " Original Medical Papers by John Locke, pre- sented by Wm. Seward, Esq. ; " and its contents are 1. Hydrops. 2. Rheumatismus. 3. Hydrops. 4. Febris luflammatoria. To us now it seems curious to think of the author of the Essay on Human Understanding recording all the aches and doses and minute miseries of an ancilla culm- aria virgo, and to find that after a long and -anxious case he was turned off, when, as he says, his impatient pa- tient olio advocato medico erumpsit (!) I cannot help reminding my young friends of the value of his posthumous little book on the Conduct of the Understanding. I am glad to see that Bell and Daldy have published this precious legacy to the youth of England for the first time, (!) introduced and edited by Mr. Bolton Corney : it is a book every father should give his son. There is interesting matter in this letter besides its immediate subjects ; and some things, I rather think, un- known before of Sydenham's college life. It is the only bit of English by its author, except a letter to the Hon- orable Robert Boyle, quoted in Latham's Life. 23 RUTLAND STREET, October 13, 1859. LOCKE AND SYDENHAM. "Us n'etoient pas Savans, mais Us etoient Sages." " PHILOSOPHIA dinditur in SCIENTIAM et HABITUM unam illam qui didicit, et favenda et vitanda prcecepit, nondum SAPIENS est, nisi in ea qua didicit, animus ejus transfiguratus est." LOCKE AND SYDENHAM. studies of Metaphysics and Medicine have more in common than may perhaps at first sight appear. These two sciences, as learnt, taught, and practised by the two admirable men we are about to speak of, were ill the main not ends in them- selves, but means. The one, as Locke pursued it, is as truly a search after truth and matter of fact, as the other ; and neither Metaphysics nor Medicine is worth a rational man's while, if they do not issue certainly and speedily in helping us to keep and to make our minds and our bodies whole, quick, and strong. Soundness of mind, the just use of reason what Arnauld finely calls droiture de I'dme and the cultivation for good of our entire thinking nature, our common human understand- ing, is as truly the one great end of the Philosophy of Mind, as the full exercise of our bodily functions, and their recovery and relief, when deranged or impaired, is of the Science of Medicine, the Philosophy of Heal- ing ; and no man taught the world to better purpose than did John Locke, that Mental science, like every other, is founded upon fact upon objective realities, upon an induction of particulars, and is in this sense as much a matter of proof as is carpentry, or the doctrine of projectiles. The Essay on Human Understanding contains a larger quantity of facts about our minds, a greater amount of what everybody knows to be true, 42 LOCKE AND SYDENHAM. than any other book of the same nature. The reason- ings may be now and then erroneous and imperfect, but the ascertained truths remain, and may be operated upon by all after-comers. John Locke and Thomas Sydenham the one the founder of our analytical philosophy of mind, ami the other of our practical medicine were not only great personal friends, but were of essential use to each other in their respective departments ; and we may safely affirm, that for much in the Essay on Human Under- standing we are indebted to its author's intimacy with Sydenham, " one of the master builders at this time in the commonwealth of learning," as Locke calls him, in company with " Boyle, Huygens, and the incomparable Mr. Newton." And Sydenham, it is well known, in his dedicatory letter to their common friend Dr. Mapletoft, prefixed to the third edition of his Observations Med- icce, expresses his obligation to Locke in these words : " Nosti prceterea, quam huic meae methodo suffragantem habeam, qui earn intimius per ornnia perspexerat, utrique nostrum conjunctissimum Domimim Johannem Lock ; quo quidem viro, sive ingenio judicioque acri et suh- acto, sive etiam antiquis (hoc est optimis) moribus, vix superiorem quenquam inter eos qui nunc sunt homines repertum iri confido, paucissimos certe pares." Refer- ring to this passage, when noticing the early training of this ingenium judiciumque acre et subactum, Dugald Stewart says, with great truth, " Xo science could have been chosen, more happily calculated than Medicine, to prepare such a mind for the prosecution of those spec- ulations which have immortalized his name ; the com- plicated and fugitive and often equivocal phenomena of disease requiring in the observer a far greater pro- LOCKE AND SYDENHAM. 43 portion of discriminating sagacity than those of Physics, strictly so called ; resembling, in this respect much more nearly, the phenomena about which Metaphysics, Ethics, and Politics are conversant." And he shrewdly adds, " I have said that the study of Medicine forms one of the best preparations for the study of Mind, to such an understanding as Locke's. To an understanding less comprehensive, and less cultivated by a liberal educa- tion, the effect of this study is like to be similar to what we may have in the works of Hartley, Darwin, and Cabanis ; to all of whom we may more or less apply the sarcasm of Cicero on Aristoxenus the musician, who at- tempted to explain the nature of the soul by comparing it to a harmony ; Hie ab artificio suo non recessit." The observational and only genuine study of mind not the mere reading of metaphysical books, and know- ing the endless theories of mind, but the true study of its phenomena has always seemed to us (speaking gud medici) one of the most important, as it certainly is the most studiously neglected, of the accessary disci- plines of the student of medicine. Hartley, Mackintosh, and Brown were physicians ; and we know that medicine was a favorite subject with Socrates, Aristotle, Bacon, Descartes, Berkeley, and Sir William Hamilton. We wish our young doctors kept more of the company of these and suchlike men, and knew a little more of the laws of thought, the nature and rules of evidence, the general procedure of their own minds in the search after the proof and the applica- tion of what is true, than we fear they generally do. 1 1 Pinel states, with much precision, the necessity there is for physi cians to make the mind of man, as \vell as his body, their especial study. "L'histoire de 1'entendement humain, pourroit-elle etre ignoree par le 44 LOCKE AND SYDENHAM. They might do so without knowing less of their Aus- cultation, Histology, and other good things, and with knowing them to better purpose. "We wonder, for in- stance, how many of the century of graduates sent forth from our famous University every year armed with microscope, stethoscope, uroscope, pleximeter, etc., and omniscient of rules and rhonchi sibilous and sonorous ; crepitations moist and dry ; bruits de rape, de scie, et de soufflet ; blood plasmata, cytoblasts and nucleated cells, and great in the infinitely little, we wonder how many of these eager and accomplished youths could "unsphere the spirit of Plato," or are able to read with moderate relish and understanding one of the Tusculan Disputations, or have so much as even heard of Butler's Three Sermons on Human Nature, Berkeley's Minute Philosopher, or of a posthumous Essay on the Conduct of the Understanding? of which Mr. Hallam says, " I cannot think any parent or instructor justified in neglect- ing to put this little treatise in the hands of a boy about the time that the reasoning faculties become developed," and whose admirable author we shall now endeavor to prove to have been much more one of their own guild than is generally supposed. In coming to this conclusion, we have been mainly in- debted to the classical, eloquent, and conclusive tract by me'decin, qui a non-seulement a de"crire les ve'sanies ou maladies mo- rales, et a indiquer toutes leurs nuances, mais encore, qui a besoin de porter la logique la plus severe pour eViter de donner de la rdalite' a de terraes abstraits, pour proce'der avec sagesse des ide"es simples a de3 ide'es complexes, et qui a sans cesse sous ses yeux des cents oil le d&- faut de s'entendre, la seduction de 1'esprit de systeme, et 1'abus des expressions vagues et inde'termine'es ont amene" de milliers des volumes et des disputes interminables ? " Methodes d'etudier en Medecine. 1 There is a handsome reprint of this " pith of sense " put forth the other day by Bell & Daldy. LOCKE AND SYDEXHAM. 45 Lord Grenville, 1 entitled, Oxford' and Locke; to Lord King's Life of his great kinsman; to Wood's Athence and Fasti Oxonienses ; to the letters from Locke to Drs. Mapletoft, Molyneux, Sir Hans Sloane, and Boyle, pub- lished in the collected edition of his works ; to Ward's Lives of the Gresham Professors ; and to a very curious collection of letters of Locke, Algernon Sidney, the second Lord Shaftesbary, and others, edited and pri- vately printed by Dr. Thomas Forster ; and to a Medi- cal Commonplace Book, and many very interesting let- ters on medical subjects, by his great kinsman, in the possession of the Earl of Lovelace, and to which, by his Lordship's kindness, we have had access ; some of the letters are to Fletcher of Saltoun, on the health of his brother's wife, and, for unincumbered good sense, ra- tional trust in nature's vis medicatrix, and wholesome fear of polypharmacy and the nimia diligentia of his time, might have been written by Dr. Combe or Sir Tames Clark. Le Clerc, in his Eloge upon Locke in the Bibliotheque Choisie (and in this he has been followed by all subse- quent biographers), states, that when a student at Christ Church, Oxford, he devoted himself with great earnest- ness to the study of Medicine, but that he never prac- tised it as his profession, his chief object having been to qualify himself to act as his own physician, on account of his general feebleness of health, and tendency to con- sumption. To show the incorrectness of this statement, we give the following short notice of his medical studies and practice ; it is necessarily slight, but justifies, we think, our assertion in regard to him as a practitioner in medicine. i See Note A. 46 LOCKE AND SYDENHAM. LOCKE was born in 1632 at Wrington, Somersetshire, on the 29th of August, the anniversary, as Dr. Forster takes care to let us know, of the Decollation of St. John the Baptist eight years after Sydenham, and ten before Newton. He left Westminster School in 1651, and entered Christ Church, distinguishing himself chiefly in the departments of medicine and general physics, and greatly enamored of the brilliant and then new philos- ophy of Descartes. In connection with Locke's university studies, An- thony Wood, in his autobiography, has the following cu- rious passage : " I began a course of chemistry under the noted chemist and rosicrucian Peter Sthael of Stras- burg, a strict Lutheran, and a great hater of women. The club consisted of ten, whereof were Frank Turner, now Bishop of Ely, Benjamin Woodroof, now Canon of Christ Church, and John Locke of the same house, now a noted writer. This same John Locke was a man of a turbulent spirit, clamorous, and never contented ; while the rest of our club took notes from the mouth of their master, who sat at the upper end of a long table, the said Locke scorned to do this, but was for ever prating and troublesome." This misogynistical rosicrucian was brought over to Oxford by Boyle, and had among his pu- pils Sir Christoper Wren, Dr. Wallis, and Sir Thomas Millington. The fees were three pounds, one-half paid in advance. Locke continued through life greatly addicted to med- ical and chemical researches. He kept the first regular journal of the weather, and published it from time to time in the Philosophical Transactions, and in Boyle's History of the Air. He used in his observations a ba- rometer, a thermometer, and a hygrometer. His letters LOCKE AND SYDENHAM. 47 to Boyle are full of experiments and speculations about chemistry and medicine ; and in a journal kept by him when travelling in France is this remarkable entry : " M. Toinard produced a large bottle of muscat ; it was clear when he set it on the table, but when the stopper was drawn, a multitude of little bubbles arose. It comes from this, that the included air had liberty to expand it- self : query, whether this be air new generated. Take a bottle of fermenting liquor, and tie a bladder over its mouth, how much new air will this produce, and has this the quality of common air ?" "We need hardly add, that about a hundred years after this Dr. Black answered this capital query, and in doing sp, transformed the whole face of chemistry. We now find that, in contradiction to the generally received account, " sour " Anthony Wood, who was an Oxford man and living on the spot, says in his spiteful way, " Mr. Locke, after having gone through the usual courses preparatory to practice, entered upon the physic line and got some business at Oxford." Nothing can be more explicit than this, and more directly opposed to Le Clerc's account of his friend's early life, which, it may be remembered, was chiefly derived from notes furnished by the second Lord Shaftesbury, whose information must necessarily have been at second or third hand. In 1GG6, Lord Ashley, afterwards the first Lord Shaftes- bury, came to Oxford to drink the water of Astrop ; he was suffering from an abscess in his chest, the conse- quence of a fall from his horse. Dr. Thomas, his lord- ship's attendant, happening to be called out of town, sent his friend Locke, then practising there, who exam- ined into his complaints, and advised the abscess to be opened ; this was done, and, as the story goes, his lord 48 LOCKE AND SYDENHAM. ship's life was saved. From this circumstance took its origin the well-known friendship of these two famous men. That their connection at first was chiefly that of patient and doctor, is plain from the expression, " lie, the Earl, would not suffer him to practise medicine out of his house, except among some of his particular friends," implying that he was practising when he took him. In 1668, Locke, then in his thirty-sixth year, accom- panied the Earl and Countess of Northumberland to the Continent, as their physician. The Earl died on his journey to Rome, leaving Locke with the Countess in Paris. When there, he attended her during a violent attack of what seems to have been tic-douloureux, an in- teresting account of which, and of the treatment he adopted, was presented by the late Lord King to the London College of Physicians and read before them in 1829. By the great kindness of the late Dr. Paris, President of the College, we had access to a copy of this medical and literary curiosity, which, besides its own value as a plain, clear statement of the case, and as an example of simple skilful treatment, is the best of all proofs that at that time Locke was a regular physician. We cannot give it higher praise, or indicate more signif- icantly its wonderful superiority to the cases to be found in medical authors of the same date, than by saying that in expression, in description, in diagnosis, and in treat- ment, it differs very little from what we have in our own best works. After the Earl's death, Locke returned to England, and seems to have lived partly at Exeter House with Lord Shaftesbury, and partly at Oxford. It was in 1670, at the latter place, that he sketched the first out- LOCKE AND SYDENHAM. 49 line of bis immortal Essay, the origin of which he has so modestly recorded in his Epistle to the Reader. Dr. Thomas, and most probably Dr. Sydenham, were among the " live or six friends meeting at my chamber," who started the idea of that work, " which has done more than any other single work to rectify prejudice, to un- dermine established errors, to diffuse a just mode of thinking, to excite a fearless spirit of inquiry, and yet to contain it within the boundaries nature has set to the human faculties. If Bacon first discovered the rules by whicli knowledge is to be advanced, Locke has most contributed by precept and example to make mankind at large observe them, and has thus led to that general dif- fusion of a healthful and vigorous understanding, which is at once the greatest of all improvements, and the instrument by which all other improvements must be accomplished." About this time, Locke seems to have been made a Fellow of the Royal Society. In 1674, he took the de- gree of Bachelor of Medicine ; he "never was Doctor of Medicine, though he generally passed among his friends as Dr. Locke. In 1G75, he went abroad for his health, and appar- ently, also, to pursue his medical studies. He remained for some time at Montpellier, then the most famous of the schools of medicine. He attended the lectures of the celebrated Barbeyrac, to whose teaching Sydenham is understood to have been so much indebted. When there, and during his residence abroad, he kept a diary, large extracts from which are for the first time given by Lord King. 1 The following is his account of -the an- 1 Lord King refers to numerous passages in Locke's Diaries exclu- sively devoted to medical subjects, which lie has refrained from pub- 4 50 LOCKE AND SYDEXHAM. nual " capping " at Montpellier. " The manner of mak- ing a Doctor of Physic is this : 1st, a procession in scarlet robes and black caps the professor took his seat and after a company of fiddlers had played a cer- tain time, he made them a sign to hold, that he might have an opportunity to entertain the company, which he did in a speech against innovations the musicians then took their turn. The Inceptor or candidate then began his speech, wherein I found little edification, being chiefly complimentary to the chancellor and professors, who were present. The Doctor then put on his head the cap that had marched in on the beadle's staff, in sign of his doctorship put a ring upon his finger girt himself about the loins with a gold chain made him sit down beside him that having taken pains he might now take ease, and kissed and embraced him in token of the friendship which ought to be amongst them." From Montpellier he went to Paris, and was a dili- gent student of anatomy under Dr. Guenelon, with whom he was afterwards so intimate, when living in exile at Amsterdam. In June 1G77, when in Paris, he wrote the following jocular letter to his friend Dr. Mapletoft, then physic professor at Gresham College. This letter, which is not noticed in any life of Locke that we have seen, is thus introduced by Dr. Ward: "Dr. Mapletoft did not lishing, as unlikely to interest the general public ; and Dr. Forster gives us to understand that he has in his possession "some ludicrous, sarcastic, and truly witty letters to his friend Furley on medicine, his original profession ; " but which letters the Doctor declines Riving to the public "in these days of absurd refinement." We would gladly forswear our refinement to have a sight of them ; anything that Locke considered worth the writing down about anything is likely to be worth the reading. LOCKE AND SYDENHAM. i>l sontinue long at Gresliam, and yet longer than he seenis to have designed, by a letter to him, written by the fa- mous Mr. John Locke, dated from Paris, 22d June 1677, in which is this passage : ' If either absence (which sometimes increases our desires) or love (which we see every day produces strange effects in the world) have softened you, or disposed you towards a liking for any of our fine new things, 't is but saying so, and I am ready to furnish you, and should be sorry not to be employed ; I mention love, for you know I have a particular inter- est of my own in it. When you look that way, nobody will be readier, as you may guess, to throw an old shoe after you, much for your own sake, and a little for a friend of yours. But were I to advise, perhaps I should say that the lodgings at Gresham College were a quiet and comfortable habitation.' By this passage," con- tinues Ward, "it seems probable that Dr. Mapleteft had then some views to marriage, and that Dr. Luoke was desirous, should it so fall out, to succeed him. But neither of these events happened at the time, for the Dr. held his professorship till the 10th October 1G79, and, in November following, married Rebecca, the daughtei of Mr Lucy Knightley of Hackney, a Hamburg mer- chant." And we know that on the 10th of May that same year, Locke was sent for from Paris by Lord Shaftesbury, when his Lordship was made President of Sir William Temple's Council, half a year after which they were both exiles in Holland. As we have already said, there is something very characteristic in this jocu- lar, paivky, affectionate letter. There can be little doubt from this, that so late as 1677, when he was forty-five years of age, Locke was able and willing to undertake the formal teaching of medicine. 52 LOCKE AND SYDEXHAM. It would not be easy to say how much mankind would have at once lost and gained how much the philosophy of mind would have been hindered, and how much that of medicine would have been advanced, had John Locke's lungs been as sound as his understanding, and h;ul he "stuck to the physic line," or had his friend Dr. Maple- toft " looked that way " a little earlier, and made Re- becca Knightley his wife two years sooner, or had Lord Shaftesbury missed the royal reconcilement and his half- year's presidency. Medicine would assuredly have gained something it still lacks, and now perhaps more than ever, had that " friend of yours," having thrown the old shoe with due solemnity and precision after the happy couple, much for their sakes and a little for his own, settled down in that quiet, comfortable, baccalaurian habitation, over- against the entrance into Bishopsgate Street ; and had thenceforward, in the prime of life, directed the full vigor of that liberal, enlightened, sound, humane, and practical understanding, to the exposition of what Lord Grenville so justly calls " the large and difficult" sub- ject of medicine. "What an amount of gain to rational and effective medicine what demolition of venerable and mischievous error what fearless innovations what exposition of immediately useful truth what an example for all future laborers in that vast and perilous field, of the best method of attaining the best ends, might not have been expected from him of whom it was truly said that " he knew something of everything that could be useful to mankind ! " It is no wonder then, that, looking from the side of medicine, we grudge the loss of the Locke " Physic Lectures," and wish that we might, without fable, imagine ourselves in that quaint, LOCKE AND SYDENHAM. 53 Bteep-roofed quadrangle, with its fifteen trees, and its diagonal walks across the green court ; and at eight o'clock, when the morning sun was falling on the long legs and antennae of good Sir Thomas's gilded grasshop- pers, and the mighty hum of awakening London was beginning to rise, might figure to ourselves the great philosopher stepping briskly through the gate into his . ecture-room his handsome, serious face, set " in his nood, according to his degree in the university, as was thought meet for more order and comeliness sake," and there, twice every week in the term, deliver the " sol- emn Physic Lecture," in the Latin tongue, in dutiful ac- cordance with the " agreement, tripartite, between the mayor, commonalty, and citizens of London the war- dens and commonalty of the mystery of mercers, and the Lecturers in Gresham House ; " and again, six hours later, read the same " solemn lecture," we would fancy with more of relish and spirit, in the " English tongue," " forasmuch," so the worthy Founder's will goes, " as the greater part of the auditory is like to be of such cit- izens and others as have small knowledge, or none at all, of the Latin tongue, and for that every man, for his health's sake, will desire to have some knowledge of the art of physic." "We have good evidence, from the general bent and spirit of Locke's mind, and from occasional passages in his letters, especially those to Dr. Molyneux, that he was fully aware of the condition of medicine at that time, and of the only way by which it could be im- proved. "Writing to Dr. Molyneux, he says ; " I per- fectly agree with you concerning general theories the curse of the time, and destructive not less of life than of science they are for the most part but a sort of wak- 54 LOCKE AND SYDEXHAM. ing dream, with which, when men have warmed theii heads, they pass into unquestionable truths. This is be- ginning at the wrong end, men laying the foundation in their own 'fancies, and then suiting the phenomena of diseases, and the cure of them, to these fancies. I won- der, after the pattern Dr. Sydenham has set of a better way, men should return again to this romance-way of physic. But I see it is more easy and more natural for men to build castles in the air of their own than to survey well those that are on the ground. Nicely to observe the history of diseases in all their changes and circumstances is a work of time, accurateness, attention, and judgment, and wherein if men, through prepossession or oscitancy, mistake, they may be convinced of their error by unerr- ing nature and matter of fact. What we know of the works of nature, especially in the constitution of health and the operations of our own bodies, is only by the sen- sible effects, but not by any certainty ice can have, of the tools she uses, or the ways she works by." Exact, patient, honest, " nice " observation, is neither easy nor common ; as Buffon says : " II y a une espece de force de genie, et de courage d'esprit, a pouvoir en- visager sans s'e'tonner, la Nature dans la multitude in- nombrable de ses productions, et a se croire capable de les comprendre et de les comparer ; il y a une espece de gout, a les aimer, plus grand que le gout qui n'a pour but, que des objets particuliers, et 1'un peut dire, que . amour et 1'etude de la Nature, suppose dans 1'esprit deux qualites qui paroissent opposees, les grandes vues d ? un genie ardent, qui embrasse tout d'un coup-d'ceil, et les petites attentions d'un instinct laborieux, que ne s'attache qu'a un seul point." Gaubius calls it " masculum illud observandi studium LOCKE AND SYDENHAM. 55 veteribus tantopere excultum ; " and Dr. Samuel Brown, heu nimium brevis cevi decus et desiderium ! thus en- forces the same truth : " Few people are aware of the difficulty of the art of simple observation ; to observe properly in the simplest of the physical sciences requires a long and severe training. No one knows this so feel- ngly as the great discoverer. Faraday once said that Jb always doubts his own observations. Mitscherlich said it required fourteen years to discover and establish a single new fact in chemistry. An enthusiastic student one day betook himself to Cuvier with a new muscle he supposed he had discovered. The master bade his scholar return to him with the same discovery in six months ! " But we must draw this notice of Locke in his char- acter of Doctor to a close. In the Philosophical Trans- actions for 1697, there is an account by him of an odd case of hypertrophied nails, which he had seen at La Charite when in Paris, and he gives pictures of the hornlike excrescences, one of them upwards of four inches long. The second Lord Shaftesbury, who was Locke's pupil, and for whom he chose a wife, id a letter to Furley, who seems to have been suffering from a re- lapse of intermittent fever, explains, with great distinct- ness and good sense, " Dr. Locke's and all our ingenious and able doctors' method " of treating this disease with the Peruvian bark ; adding, " I am satisfied, that of all medicines, if it be good of its kind, and properly given, it is the most innocent and effectual, whatever bugbear the world makes of it, especially the tribe of inferior physicians, from whom it cuts off so much business and gain." We now conclude our notices of Locke's medi- cal history which, however imperfect, seem to us to 56 LOCKE AND STDEXHAM. warrant our original assertion with the following weighty sentence taken from the " Fragment on Study " given hy Lord King, and which was written when Locke was at his studies at Oxford. It accords curiously with what we have already quoted from Dugald Stewart : " Physic, polity, and prudence are not capable of dem- onstration, but a man is principally helped in them, 1, By the history of matter of fact ; and, 2, By a sagac- ity of inquiring into probable causes, and finding out an analogy in their operations and effects. Whether a cer- tain course in public or private affairs will succeed well whether rhubarb will purge, or quinquina cure an ague, can be known only by experience." 1 SYDENHAM, the prince of practical physicians, whose character is as beautiful and as genuinely English as his name, did for his art what Locke did for the philosophy of mind he made it, in the main, observational ; he made knowledge a means, not an end. It would not be easy to over-estimate our obligations as a nation to these two men, in regard to all that is involved in the promo- 1 The all-accomplished, and, in the old sense, "the admirable" Dr. Thomas Young, puts this very powerfully in the preface to his Intro- duction to Medical Literature. "There is, in fact, no study more lifficult than that of physic ; it exceeds, as a science, the comprehen- sion of the human mind; and those who blunder onwards, without at- empting to understand what they see, are often nearly on a level with Ihose who depend too much upon imperfect generalizations." " Some departments of knowledge defy all attempts to subject them to any didactic method, and require the exercise of a peculiar address, a judg- ment, or a taste, which can only be formed by indirect means. It appears that physic is one of those departments in which there is frequent necessity for the exercise of an incommunicable faculty oj 'udgifient, and a sagacity which may be called transcendental, as ex* tending beyond the simple combination of all that can be taught b$ precept " LOCKE AND SYDENHAM. 57 tion of health of body and soundness of mind. They were among the first in their respective regions to show their faith in the inductive method, by their works. They both professed to be more of guides than critics, and were the interpreters and servants of Nature, not her diviners and tormentors. They pointed out a way, and themselves walked in it ; they taught a method and used it, rather than announced a system or a discovery ; they collected and arranged their visa before settling their cogitata a mean-spirited proceeding, doubtless, in the eyes of the prevailing dealers in hypotheses, being in reality the exact reverse of their philosophy. How curious, how humbling, to think that it was not till this time, that men in search of truth were brought to see that " it is not the insufficiency or incapacity of man's mind, but the remote standing or placing thereof, that breedeth mazes and incomprehensions ; for as the sense afar off is full of mistaking, but is exact at hand, so is it of the understanding, the remedy whereof is not to quicken or strengthen the organ, but to go nearer to the object." Well might this greatest of Lord Chancellors now even say, as he does in the context (he is treating of medi- cine) " Medicine is a science which hath been more professed than labored, more labored than advanced, the labor being in my judgment more in a circle than in progression : I find much iteration but small addi tion ; " and he was right in laying much of this evil con- dition to the discontinuance of " the ancient and serious diligence of Hippocrates." This serious diligence, this dK/H/3eia or nicety of observation by which the " divine, old man of Cos " achieved so much, was Sy denham's master-principle in practice and in speculation. He pro- claimed it anew, and displayed in his own case its certain and inestimable fruits. 58 LOCKE AND SYDEXHAM. It appears to us one of the most interesting, as it is certainly one of the most difficult and neglected depart- ments of medical literature, to endeavor to trace the progress of medicine as a practical art, with its rules and instruments, as distinguished from its consolidation into a systematic science with its doctrines and laws, and to make out how far these two, which conjoined form the philosophy of the subject, have or have not harmonized with, and been helpful to each other, at dif- ferent periods of their histories. Much might be done to make such an inquiry instructive and attractive, by marking out the history of medicine into several great epochs, and taking, as representative of each, some one distinguished artsman or practitioner, as well as teacher or discoverer. He might have Hippocrates and his epoch, Sydenham and his, John Hunter, Pinel. Laennec and theirs. These great men differed certainly widely enough in character and in circumstances, but agreed all in this, their possessing in large measure, and of rare quality, that native sagacity, that power of keen, serious, choice, patient, continuous, honest observation, which is at once a gift and a habit; that instinct for seeking and finding, which Bacon calls " experientia literala, saga- citas polius et odoratio qucedam venatica, quam scien- tia;" that general strength and soundness of under- standing, and that knack of being able to apply their knowledge, instantly and aright, in practice, which must ever constitute the cardinal virtues of a great physician, the very pith and marrow of his worth. Of the two first of these famous men, we fear there survives in the profession little more than the names ; and we receive from them, and are made wiser and bet- ter by inheriting, their treasures of honest and exquisite LOCKE AND SYDENHAM. 59 observation, of judicious experience, without, we fear, knowing or caring much from whom it has come. " One man soweth, and another reapeth." The young forget the old, the children their fathers ; and we are all too apt to reverse the saying of the wise king, " I praised the dead that are already dead, more than the living that are yet alive." As we are not sufficiently conscious of, so we assur- edly are not adequately grateful for, that accumulated volume of knowledge, that body of practical truth, which comes down as a heritage to each one of us, from six thousand years of human endeavor ; and which, like a mighty river, is moving forever onwards widening, deepening, strengthening, as it goes ; for the right ad- ministration and use of whose untold energies and wealth, we, to whom it has thus far descended, are re- sponsible to Him from whom it comes, and to whom it is hastening responsible to an extent we are too apt to forget, or to underrate. We should not content our- selves with sailing victoriously down the stream, or with considering our portion of it merely ; we should go up the country oftener than we do, and see where the mighty feeders come in, and learn and not forget their names, and note how much more of volume, of momen- tum, and power, the stream has after they have fallen 'n. It is the lot of the successful medical practitioner, who is more occupied with discerning diseases and curing them, than with discoursing about their essence, and ar- ranging them into systems, who observes and reflects in order to act rather than to speak, it is the lot of such \nen to be invaluable when alive, and to be forgotten soon after they are dead ; and this not altogether or 60 LOCKE AND SYDENHA5I. chiefly from any special ingratitude or injustice on the part of mankind, but from the very nature of the case. Much that made such a man what the community to their highest profit found him to be, dies, must die, with him. His inborn gifts, and much of what was most val- uable in his experience, were necessarily incommunica- ble to others, this depending somewhat on his forgetting the process by which, in particular cases, he made up his mind, and its minute successive steps, from his eagerness to possess and put in action the result, arid likewise from his being confident in the general sound- ness of his method, and caring little about formally re- cording to himself his transient mental conditions, much less announcing them articulately to others ; but mainly, we believe, because no man can explain directly to an- other man how he does any one practical thing, the do- ing of which he himself has accomplished, not at once, or by imitation, or by teaching, but by repeated personal trials, by missing much, before ultimately hitting. You may be able to expound excellently to your son the doctrines of gunnery, or read him a course of lec- tures upon the principles of horsemanship, but you can- not transfer to him your own knack as a dead-shot, or make him keep his seat over a rasping fence. He must take pains to win these for himself, as you have done before him. Thus it is that much of the best of a man like Sydenham, dies with him. It is very different with those who frequent the field of scientific discovery. Here matters are reversed. No man, for instance, in teaching anatomy or physiology, when he comes to enounce each new subordinate discov- ery, can fail to unfold and to enhance the ever-increas- ing renown of that keen UacJc-a-vised little man, with his LOCKE AND SYDENHAM. 61 piercing eye, " small and dark, and so full of spirit ; " his compact, broad forehead, his self-contained, peremp- tory air, his dagger at his side, and his fingers playing with its hilt, to whom we owe the little book, JDe motu cordis et sanguim's circulatione. This primary, capital discovery, which no succeeding one can ever supersede or obscure, he could leave consummate to mankind ; but he could not so leave the secret of his making it ; he could not transmit that combination of original genius, invention, exactness, perseverance, and judgment, which enabled him, and can alone enable any man, to make such a permanent addition to the fund of scientific truth. But what fitted Harvey for that which he achieved, greatly unfitted him for such excellence in practice as Sydenham attained. He belonged to the science more than to the art. His friend Aubrey says of him, that " though all his profession would allow him to be an ex- cellent anatomist, I have never heard of any who ad- mired his therapeutic way." A mind of his substance and mettle, speculative and arbitrary, passing rapidly and passionately from the particular to the general, from multiformity to unity, with, moreover, a fiery temper and an extemporaneous dagger as its sting, was not likely to take kindly to the details of practice, or make a very useful or desirable family doctor. Sydenham, again, though his works everywhere manifest that he was gifted with ample capacity and keen relish for ab- stract truth, moved habitually and by preference in the lower, but at the time the usefuller sphere of every- day practice, speculating chiefly in order to act, reducing his generalizations back to particulars, so as to answer some immediate instance, the result of which was the sig- vallest success of " his therapeutic way." We have had 32 LOCKE AND SYDEXHAM. in our own day two similar examples of the man of sci- ence and the man of art ; the one, Sir Charles Bell like Harvey, the explorer, the discoverer, the man of genius and science, of principles and laws, having the royal gifts of invention and eloquence was not equally endowed with those homelier, but in their degree not less rare qualities, which made Dr. Abercrombie, our Scottish Sydenham, what he was, as a master in the di- agnosis and treatment of disease. The one pursued his profession as a science, to be taught, to be transmitted in its entireness the other as an art to be applied. The one was, in the old phrase, luciferons ; the other frugiferous. One great object we have in now bringing forward the works and character of Sydenham, is to enforce the primary necessity, especially in our day, of attending to medicine as the art of healing, not less than as the science of diseases and drugs. We want at present more _ of the first than of the second. Our age is becoming every day more purely scientific, and is occupied far more with arranging subjects and giving names, and re- membering them, than with understanding and manag- ing objects. There is often more knowledge of words than of things. "We have already stated our notion, that to the great body of modern physicians, Sydenham is little more than a name, and that his works, still more than those of his companion Locke, are more spoken of than read. Thi is owing to several causes : partly to their being buried in Latin, which men seem nowadays ashamed to know; partly to much in them being now scientifically obsolete and useless ; partly from their practical value being im- paired by our ignorance of his formulas of cure ; and LOCKE AND SYDENHAM. 63 greatly also, we fear, from what Baglivi calls " an inept derision and neglect of the ancients," which is more prev- alent than seemly. We include ourselves among these ; for until we got Dr. GreenhilPs edition, we had never read seriously and thoroughly these admirable tracts, which were all of an occasional character, and were forced from their author by the importunity of friends, or the envious calumny of enemies, often in the form of familiar letters. We had, when at college, picked up like our neigh- bors the current commonplaces about Sydenham ; such as that he went by the name of " the Prince of English physicians ; " that Boerhaave (of whom by the way we knew quite as little, unless it were a certain awful ac- quaintance with his ugly, squab, and gilded visage, which regarded us grimly from above a druggist's door, as we hurried along the Bridges to the University) was wont to take his hat off, whenever he mentioned his name, and to call him " Anglice lumen, Artis Phoebum, veram Hippocratici veri speciem : " that his life was written by Samuel Johnson in the Gentleman's Magazine, and was one of his earliest and worst paid performances : that he was a Whig, and went into the field as a Parliament man. Moreover, that when asked by Sir Richard Black- more what he would advise him for medical reading, he replied, " Head Don Quixote, Sir," an answer as full of sense as wit, and the fitness and wisdom of which it would be not less pleasant than profitable to unfold at length. We had been told also, in a very general way by our teachers, that Sydenham had done some things for his profession, which, considering the dark age in which he worked, were highly to his credit ; that his name was well connected with the history and manage- 64 LOCKE AND SYDEXHAM. ment of the small-pox ; the nature of epidemics, the con- stitutions of years, dropsies, etc., and that he had re- corded his own sufferings from the gout in a clever and entertaining way. All this was true, hut by no means the whole truth. Not only are his observations invaluable to anyone en- gaged in tracing the history of medicine as a practical art, and as an applied science ; in marking in what re- spects it is changed, and in what unchanged ; in how much it is better now than then, and in what little it is not so good. In addition to all this, they are full of val- uable rules for the diagnosis and treatment of disease ; and we can trace to him as their origin, many of our most common and important therapeutic doctrines. They everywhere manifest how thoroughly he practised what he taught, how honestly he used his own "method," that of continued, close, serious observation. But we confess, after all, our chief delight is from the discovery he makes in his works of his personal character the exemplar he furnishes in himself of the four qualities Hippocrates says are indispensable in every good physi- cian learning, sagacity, humanity, probity. This per- sonality gives a constant charm to everything he writes, the warmth of his large, humane, practical nature is felt throughout. Above all, we meet with a habitual reference to what ought to be the supreme end of every man's thoughts and energies the two main issues of all his endeavors, the glory of God and the good of men. Human life was to him a sacred, a divine, as well as a curious thing, and he seems to have possessed through life, in rare acuteness, that sense of the value of what was at stake of the perilous material he had to work in, and LOCKE AND SYDENHAM. 6& gentleness and compassion for his suffering fellow-men, without which no man be his intellect ever so tran scenclent, his learning ever so vast, his industry ever so accurate and inappeasable need hope to be a great physician, much less a virtuous and honest man. This characteristic is very striking. In the midst of the most minute details, and the most purely professional state- ments, he bursts out into some abrupt acknowledgment of "The Supreme Judge," "The true Archiater and Archeus." We may give one among many such in- stances. He closes his observations on The Epidemic Cough and Pleurisy Peripneumony of 1675, with this sudden allusion to the Supreme Being : " Qui post se- quentur morbi, solus novit, Qui novit omnia. And again, after giving his receipt for the preparation of his laudanum liquidum, so much of Spanish wine, of opium, of saffron, of cinnamon, and cloves, he adds, " Profecto non hie mihi tempero, quin gratulabundus animadver tarn, DEUM omnipotentern TTCIVTUV ^.(orijpa fdwv non aliud remedium, quod vel pluribus malis debellandis par sit, vel eadem efficacius extirpet, humano generi in miseria- rum solatium concessisse, quam opiata." If we may adapt the simple but sublime saying of Sir Isaac Newton, Sydenham, though diligent beyond most other " children " in gathering his pebbles and shells on the shore of the great deep, and in winning for mankind some things of worth from the vast and formless infinite, was not unconscious of the mighty presence beside which he was at work ; he was not deaf to the strong music of that illimitable sea. He recognized in the midst of the known, a greater, an infinite, a divine unknown ; behind everything certain and distinct, he beheld something shadowy and unsearchable, past all fiudiqg out ; and ho 5 66 LOCKE AND SYDENHAM. did not, as many men of his class have too often done, and still do, rest in the mere contemplation and recogni- tion of the rt 0tov. This was to him but the shadow of the supreme substance, 6 eos. How unlike to this fer- vor, this reverence and godly fear, is the hard, cool, non- chalant style of many of our modern men of science, each of whom is so intent on his own little pebble, so bent upon finding in it something no one else ever found, so self-involved and self-sufficient, that his eyes and his ears are alike shut to the splendors and the voices the brooding darkness, and the " look that threatens the profane " of the liberal sea, from out whose abyss it has been flung, and " Which doth with its eternal motion make A sound like thunder everlastingly." This habit of Sydenham's mind is strikingly shown in the first sentence of his Preface to the first edition of his Medical Observations: " Qui medicinae dat operam, haac secum ut ssepe perpendat oportet : Primo, se de segrorum vita ipsius curse commissa, rationem aliquaudo SUPREMO JUDICI redditurum. Deinde quicquid artis aut scientiag Divino beneficio consecutus est, imprimis, ad SUMMI NUMINIS laudem, atque humani generis salu- tem, esse dirigendum : indignum autem esse, ut crelestia ilia dona, vel avaritia?, vel ambitus officio inserviant. Porro, se non ignobilis alicujus aut contemnendi anima- lis curam suscepisse ; ut enirn, humaui generis pretiurn agnoscas, UNIGENITCS DEI FILIUS, homo factus est adeoque naturam assumptam sua dignatione nobilitavit. Denique, nee se communi sorte, exemptum esse, sed iisdem legibus mortalitatis, iisdem casibus et osrumuis, obnoxium atque expositum, quibus alii quilibet ; quo diligentius et quidem teneriori cum afFectu, ipse plane 6/xoto7ra0v;s aegrotantibus opem ferre conetur." LOCKE AND STDENHAM. 67 When it is the free outcome of an earnest, sincere, and ample nature, this sadden reference to Divine things this involuntary Oh altitudo! in the midst of a purely technical exposition, has an effect, and moves the hearer far beyond any mere elaborate and foreseen argumenta- tion. When a youth is told beforehand what you mean to make him believe, and, above all, what you mean to insist that he must feel you have much of him against you. You should take him before he is aware; and, besides, if this burst of emotion is the expression of an inward restraint, carried to its utmost, and then forced into utterance ; if the speaker has resisted being moved, and is moved in spite of himself, then is he surest to move those upon whom he is acting. The full power of lightning is due to speed and concentration you have it in the Teutonic Blitz, gone as soon as come. Such of our readers (a fast-lessening band !) as were pupils of that remarkable man and first-rate teacher, Dr. John Barclay, must remember well his sudden bursts of this kind, made all the more memorable, that he disliked formal moralizing upon his favorite science. There was one occasion when he never failed to break out. It was when concluding his description of the bones of the skull. His old pupils knew what was com- ing, the new ones were set a wondering ; all saw some suppressed emotion working within him, his language was more close and rapid ; that homely, sensible, honest face, was eager with some unacknowledged central feel ing, and after finishing the Sella Turcica, and the clinoid processes, he threw down the sphenoid bone, and the time being up, and his hand on the open door of that well-known arena in which he moved, he seemed as if leaving ; indeed, we believe he intended then to leave. 68 LOCKE AND SYDENHAM. when turning round upon the class, with a face serious almost to anger, and a voice trembling with feeling, he said, "Yes, gentlemen! there is a God, omnipotent, omniscient, and eternal" as he vanished under the gal- lery into his room. Depend upon it, this single sentence made a deeper impression on his hearers than any more elaborate demonstration after the manner of Paley. The ardent old man did not linger among particulars, but passed at once, and with a sort of passionate fervor, to the full absolute assertion. Two examples of these brief lightnings, which at one flash " unfold both earth and heaven," occur to us now. Dr. Dick, in his System of Theology, at the close of his lecture on the Immensity and Omnipresence of the De- ity, pictures a man about to commit some great sin, as shutting himself in his room, or going into the depths of an unfrequented \wood, so as to get absolutely by him- self, and then turning and looking and looking again to make sure " let him turn and look again ! " And John Foster, in that intense bit of spiritual vivi- section, the Preface to Doddridgc's Rise and Progress, when minuting the process of a step-by-step descent into the deepest meditative wickedness and impiety, the very " superfluity of naughtiness," represents the person as speaking his last thought aloud, and starting at his own voice, and his desperate sin, and then exclaiming, "If anyone were within hearing ! " If anyone were ivithin hearing! as if some One had not all the while been within hearing. The following are a few quotations, taken at random, from Sydenham's various treatises and letters, in which we may see what he himself was as a practitioner, and what were his views as to the only way in which Medi cine, as an art, could be advanced. LOCKE AND SYDENHAM. 69 In his Epistle to Dr. Mapletoft, prefixed to the Ob- servationes Medicce, his first publication, when he was forty-two years of age, he gives his friend a long and entertaining account of his early professional life, and thus proceeds : " Having returned to London, I began the practice of Medicine, which when I studied curiously with most intent eye (intenio admodum oculo) and ut- most diligence, I carce to this conviction, which to this day increases in strength, that our art is not to be better learned than by its exercise and use ; and that it is likely in every case to prove true, that those who have directed their eyes and their mind, the most accurately and diligently, to the natural phenomena of diseases, will excel in eliciting and applying the true indications of cure. With this thread as my guide, I first applied my mind to a closer observation of fevers, and after no small amount of irksome waiting, and perplexing mental agi- tations, which I had to endure for several years, I at last fell upon a method by which, as I thought, they might be cured, which method I some time ago made public, at the urgent request of my friends." He then refers to the persecution and calumnies he had been exposed to from the profession, who looked upon him as a pestilent fellow, and a setter forth of strange doctrines ; adopting the noble saying of Titus Tacitus in reply to Metellus : " Facile est in me dicere, cum non sim respousurus ; tu didicisti maledicere ; ego, conscientia teste, didici maledicta coutemnere. Si tu lingua) tuae dominus es, et quicquid lubet effutias ; ego aurium mearum sum dominus, ut quicquid obvenerit audiant inoffensae." * It is easy to speak against me 1 Sydenham here quotes from memory, as Bacon, and many other men of that time, whose minds were full of the classics, often did, and 70 LOCKE AND SYDENHAM. when I make no reply ; you have learned to speak -evil ; I, my conscience bearing me witness, have learned to despise evil speaking. You are master of your tongue, and can make it utter what you list ; I am master of my ears, and can make them hear without being offended. And, after making the reference we have already mentioned, to his method having had the sanction and assistance of Locke, he thus concludes in regard to the ultimate success of his newly discovered way, "As concerns the future, I cast the die, not overcareful how it may fall, for, since I am now no longer young, and have, by the blessing of the Almighty, a sufficient pro- vision for the remainder of my journey (tuntum mild est viatici, quantum restat vice), I will do my best to attain, without trouble to myself or others, that measure of happiness so beautifully depicted by Politian : 'Felix ille animi, dh'isque simillimus ipsis, Quern non mendaci resplendens gloria fuco Sollicitat, non fastosi mala gaudia luxus. Sed tacitos sinit ire dies, etpaupere cultu Exiyit innocuce tranguilla silentia vitce.' " We shall now give more fully his peculiar views, and in order to render him due honor for originating and acting upon them, we must remember in the midst of what a mass of errors and prejudices, of theories actively mischievous, he was placed, at a time when the mania of hypothesis was at its height, and when the practical part of his art was overrun and stultified by vile and silly none of the commentators have discovered the exact passage. The remark is in Beyerlinck, Magn. Theatr. Vit. Human., torn. vi. page 60, H. (Lugd. 1GG6, folio), referred to by Dr. Greenhill. It is as fol- lows : "Tacitus Lucio Metello ei in Senatu maledicenti respondit, 'Facile est in me dicere, quia non responsurus sum, potentia ergo tua non mea patieutia est accusanda.' " Seneca is referred to by Beyer linck. LOCKE AND SYDENHAM. 71 nostrums. We must have all this in our mind, or we shall fail in estimating the amount of independent thought, of courage and uprightness, and of all that de- serves to be called magnanimity and virtue, which was involved in his thinking and writing and acting as he did. " The improvement of physic, in my opinion, depends, 1st, Upon collecting as genuine and natural a description or history of diseases as can be procured ; and, 2d, Upon laying down a fixed and complete method of cure. With regard to the history of diseases, whoever considers the undertaking deliberately will perceive that a few such particulars must be attended to : 1st, All diseases should be described as objects of natural history, with the same exactness as is done by botanists, for there are many diseases that come under the same genus and bear the same name, that, being specifically different, require a different treatment. The word carduus or thistle, is ap- plied to several herbs, and yet a botanist would be inac- curate and imperfect who would content himself with a generic description. Furthermore, when this distribu- tion of distempers into genera has been attempted, it has been to fit into some hypothesis, and hence this distri- bution is made to suit the bent of the author rather than the real nature of the disorder. How much this has ob- structed the improvement of physic any man may know. In writing, therefore, such a natural history of diseases, every merely philosophical hypothesis should be set aside, and the manifest and natural phenomena, how- ever minute, should be noted with the utmost exactness. The usefulness of this procedure cannot be easily over- rated, as compared with the subtle inquiries and trifling notions of modern writers ; for can there be a shorter, or 72 LOCKE AND SYDENHAM. indeed any other way, of coming at the morbific causes, or of discovering the curative indications, than by a cer- tain perception of the peculiar symptoms ? By these steps and helps it was that the father of physic, the great Hippocrates, came to excel; his theory (Oempia) be- ing no more than an exact description or view of Nature. He found that Nature alone often terminates diseases, and works a cure with a few simple medicines, and often enough with no medicines at all. If only one person in every age had accurately described, and consistently cured, but a single disease, and made known his secret, physic would not be where it now is ; but we have long since forsook the ancient method of cure, founded upon the knowledge of conjunct causes, insomuch that the art, as at this day practised, is rather the art of talking about diseases than of curing them. I make this digres- sion in order to assert, that the discovering and assigning of remote cau s, which nowadays so much engrosses the minds and feeds the vanity of curious inquirers, is an impossible attempt, and that only immediate and conjunct causes fall within the compass of our knowl- edge." Or as he elsewhere pithily states it : " Cogni- tio nostra, in rerum cortice, omnis ferme versatur, ac ad TO on sive "quod res hoc modo se habeat, fere tan turn assurgit ; TO SIOTI, sive rerum causas, nullatenus attingit." His friend Locke could not have stated the case more clearly or sensibly. It is this doctrine of "conjunct causes," this necessity for watching the action of com- pound and often opposing forces, and the having to do all this not in a machine, of which if you have seen one, you have seen all, but where each organism has often much that is different from, as well as common with all others. Here you must mend your watch while it is go- LOCKE AND SYDENHAM. 73 ing, you must shoot your game on the wing. It is this which takes medicine out of the category of exact sci- ences, and puts it into that which includes politics, ethics, navigation, and practical engineering, in all of which, though there are principles, and those principles quite within the scope of human reason, yet the application of these principles must, in the main, be left to each man's skill, presence of mind, and judgment, as to the case in hand. It is in medicine as in the piloting of a ship rules may be laid down, principles expounded, charts exhib- ited ; but when a man has made himself master of all these, he will often find his ship among breakers and quicksands, and must at last have recourse to his own craft and courage. Gaubius, in his admirable chapter, De disciplina Medici, thus speaks of the reasonable cer- tainty of medicine as distinguished from the absolute certainty of the exact sciences, and at the same time gives a very just idea of the infinite (as far as concerns our limited powers of sense and judgment) multiplicity of the phenomena of disease : " Nee vero sufficit med- icum communia modo intueri ; oportet et cuivis homini propria, quae quidem diversitas tarn immensa occurrit ut nulla observatiouum vi exhauriri possit. Sola, denique contemplutione non licet acquiescere, inque obscuris rebus suspendere judicium, donee lux affulgeat. Actio- nem exigit officium. Caplanda hinc agendi occasio, qua scepe prceceps, per conjectiiram cogit determinare, quod per scienliam sat cito nequit. Audiant hasc obtrectato- res, et cum didicerint scienlias puras, ab iis quas ap- plicatas vocaut, contemplativas a practicis, distinguere, videant quo jure medicinam pro) aliis, ut omnis certi ex- pertem, infament." 74 LOCKE AND SYDEXHAM. It would not be easy to put more important truth into clearer expression. Conjecture, in its good sense, as meaning the throwing together of a number of the ele- ments of judgment, and taking what upon the whole is the most likely, and acting accordingly, has, and will ever have, a main part to play in any art that concerns human nature, in its entireness and in action. AYhen in obscure and dangerous places, we must not contemplate, we must act, it may be on the instant. This is what makes medicine so much more of an art than a science, and dependent so much more upon the agent than upon his instructions ; and this it is that makes us so earnest in our cautions against the supposition that any amount of scientific truth, the most accurate and extensive, can in mediciJe supersede the necessity of the recipient of all this knowledge having, as Richard Baxter says, by nat- ure " a special sagacity, a naturally searching and conjecturing turn of mind." Moreover, this faculty must be disciplined and exercised in its proper function, by being not a hearer only, but also a doer, an apprentice ss well as a student, and by being put under the tutor- age of a master who exercises as well as expounds his calling. This native gift and its appropriate object have been so justly, so beautifully described by Hartley Coleridge in his Life of Fothergill, that we cannot refrain from closing our remarks on this subject by quoting his words. Do our readers know his Biographia Borealis ? If they do, they will agree with us in placing it among the pleas- antest books in our language, just such a one as Plu- tarch, had he been an Englishman, would have written : " There are certain inward gifts, more akin to geniu? than to talent, which make the physician prosper, and LOCKE AND SYDENHAM. 75 deserve to prosper; for medicine is not like practical geometry, or the doctrine of projectiles, an application of an abstract, demonstrable science, in which a certain result may be infallibly drawn from certain data, or in which the disturbing forces may be calculated with sci- entific exactness. It is a tentative art, to succeed in which demands a quickness of eye, thought, tact, inven tion, which are not to be learned by study, nor, unless by connatural aptitude, to be acquired by experience ; and it is the possession of this sense, exercised by a pa- tient observation, and fortified by a just reliance on the vis medicatrix, the self-adjusting tendency of nature, that constitutes the true physician or healer, as imagina- tion constitutes the poet, and brings it to pass, that some- times an old apothecary, not far removed from an old woman, and whose ordinary conversation savors, it may be, largely of twaddle, who can seldom give a rational account of a case or its treatment, acquires, and justly, a reputation for infallibility, while men of talent and erudition are admired and neglected ; the truth being, that there is a great deal that is mysterious in whatever is practical." But to return to our author. He was the first to point out what he called the varying " constitutions " of differ- ent years in relation to their respective epidemics, and the importance of watching the type of each new epi- demic before settling the means of cure. In none of his works is his philosophic spirit, and the subtlety and clearness of his understanding, shown more signally than in his successive histories of the epidemics of his time. Nothing equal to them has ever appeared since; and the. full importance of the principles he was the first to lay iown, is only now beginning to be acknowledged. His I 76 LOCKE AND SYDENHAM. confession as to his entirely failing to discover what made one epidemic so to differ from another, has been amply confirmed by all succeeding observers. He says, "I have carefully examined the different constitutions of different years as to the manifest qualities of the air, yet I must own I have hitherto made no progress, hav ing found that years, perfectly agreeing as to their tem- perature and other sensible properties, have produced very different tribes of diseases, and vice versa. The matter seems to stand thus : there are certain constitu- tions of years that owe their origin neither to heat, cold, dryness, nor moisture, but upon a certain secret and in- explicable alteration in the bowels of the earth, whence the air becomes impregnated with such kinds of effluvia, as subject the human body to distempers of a certain specific type." As to the early treatment of a new epidemic, he says, " My chief care, in the midst of so much darkness and ignorance, is to wait a little, and proceed very slowly, especially in the use of powerful remedies, in the mean- time observing its nature and procedure, and by what means the patient was relieved or injured ; " and he con- cludes by regretting the imperfection of his observations, ind hoping that they will assist in beginning a work that, in his judgment, will greatly tend to the advantage of mankind. Had his successors followed in his track with equal sagacity and circumspection, our knowledge of these destructive and mysterious incursions of disease would, in all likelihood, have been greatly larger and more practical than it is now. Sydenham is well known to have effected a revolution in the management of the small-pox, and to have intro- duced a method of treatment upon, which no material LOCKE AND SYDENHAM. 77 improvement has since been made. We owe the cool regimen to him. Speaking of the propriety of attend- ing to the wishes of the sufferer, he says, with equal humanity and good sense, "A person in a burning fever desires to drink freely of some small liquor ; but the rules of art, built upon some hypothesis, having a different design in view, thwart the desire, and instead thereof, order a cordial. In the mean time the patient, not being suffered to drink what he wishes, nauseates all kinds of food, but art commands him to eat. Another, after a long illness, begs hard, it may be, for some- thing odd, or questionable ; here, again, impertinent art thwarts him and threatens him with death. How much more excellent the aphorism of Hippocrates 'Such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful.' Nor will this appear strange, if it be considered that the all-wise Creator has formed the whole with such exqui- site order, that, as all the evils of nature eminently con- spire to complete the harmony of the whole work, so every being is endowed with a Divine direction or in- stinct, which is interwoven with its proper essence, and hence the safety of mankind was provided for, who, not- withstanding all our doctoring, had been otherwise in a sad enough plight." Again " He would be no honest .ind successful pilot who were to apply himself with less industry to avoid rocks and sands, and bring his vessel safely home, than to search into the causes of the ebbing and the flowing of the sea, which, though very well for a philosopher, is foreign to him whose business it is to secure the ship. So neither will a physician, whose province it is to cure diseases, be able to do so, though he be a person of great genius, who bestows less time 78 LOCKE AND SYDENHAM. on the hidden and intricate method of nature, and adapt- ing his means thereto, than on curious and subtle specu- lations." The following is frank enough : " Indeed, if I may speak my mind freel}', I have been long of opinion that I act the part of an honest man and a good physician as often as I refrain entirely from medicines, when, upon visiting the patient, I find him no worse to-day than he was yesterday ; whereas, if I attempt to cure the patient by a method of which I am uncertain, he will be endan- gered both by the experiment I am going to make on him and by the disease itself; nor will he so easily escape two dangers as one. " That practice, and that alone, will bring relief to the sufferer, which elicits the curative indications from the phenomena of the diseases themselves, and confirms them by experience, by which means the great Hippoc- rates made himself immortal. And had the art of med- icine been delivered by anyone in this wise, though the cure of a disease or two might come to be known to the common people, yet the art in its full extent would then have required men more prudent and skilful than it does now, nor would it lose any of its credit ; for as there is in the operations of Nature (on the observa- tions of which a true medical praxis is founded) more of nicety and subtlety than can be found in any art sup- ported on the most specious hypotheses, so the science of Medicine which Nature teaches will exceed an ordi- nary capacity in a much greater degree than that which mere philosophy teaches." There is much profound truth in this. Observation, in its strict sense, is not every man's gift, and but few men's actual habit of mind. Newton used to say, that LOCKE AND SYDENHAM. 79 if in any one way he differed from other men, it was in his power of continued attention of faithful, unbroken observation ; his ladder had all its steps entire, and he went up with a composed, orderly foot. It requires more strength and fineness of mind, more of what de- serves to be called genius, to make a series of genuine bservations in Medicine, or any other art, than to spin ny amount of nice hypotheses, or build any number of castella in aere" as Sydenham calls them. The observ- er's object and it is no mean one is " To know what 's what, and that 's as high As Metaphysic wit can fly." Sydenham adds, " Nor will the publication of such observations diminish but rather increase the reputation of our art, which, being rendered more difficult, as well as more useful, only men of sagacity and keen sound judgment would be admitted as physicians." How true to the sayings of his great master in his Novum Orga- num, "Nature is only subdued by submission." "The subtilty of nature is far beyond that of sense, or of the understanding, and the specious meditations and theories of mankind are but a kind of insanity, only there is no one to stand by and observe it ! " There is a very re- markable passage in Sydenham's Treatise of the Dropsy, in which, after quoting this curious passage from Hip- pocrates, " Certain physicians and philosophers say that .t is impossible for any man to understand medicine without knowing the internal structure of man ; for my part, I think that what they have written or said of nat- ure pertains less to the medical than the pictorial art," he asserts not only his own strong conviction of the im- portance of a knowledge of minute anatomy to the prac- titioner, but also his opinion that what Hippocrates 80 LOCKE AND SYDENHAM. meant, was to caution against depending too much on, and expecting too much help from, anatomical researches, to the superseding of the scrupulous observation of liv- ing phenomena, of successive actions. 1 " For in all dis- eases, acute and chronic, it must be owned there is an inscrutable TI Oeiov, a specific property which eludes the keenest anatomy." He then goes on to say, that as Hippocrates censured the abuse of anatomy, so in his own day, there were many who, in like manner, raised hopes for Physic from discoveries in Chemistry, which, in the nature of things, never could be realized, and which only served to dis- tract from the true Hippocratic method of induction ; " for the chief deficiency of medicine is not a want of efficacious medicine. Whoever considers the matter thoroughly, will find that the principal defect on the l As far as the cure of diseases is concerned, Medicine has more to do with human Dynamics than Statics, for whatever be the essence of life and as yet this rl Oeiov, this nescimus quid divinum, has defied all scrutiny it is made known to us chiefly by certain activities or changes. It is the tendency at the present time of medical research to reverse this order. Morbid anatomy, microscopical investigations, though not confined to states or conditions of parts, must regard them fully more than actions and functions. This is probably what Stahl means when he says," Ubi Physicus desinit, Medicus incipit; " and in 'he following passage of his rough Tudcsque Latin, he plainly alludes ;o the tendency, in his day, to dwell too much upon the materials of the human body, without considering its actions lt ut vivens." The passage is full of the subtilty and fire and depth of that wonderful man. " Undique hinc material advertitur animus, et quas crassius in sensum impingit conformatio, et mutua proportio corporea considera- tur ; motitum ordo, vis, et absoluta magis in materiam eneryia, tem- pora ejus, gradus, vices, maxime autem omnium, fines obiter in ani- mum admittuntur." The human machine has been compared to a watch, and some hope that in due time doctors will be as good at their craft as watchmakers are at theirs ; but watchmakers are not called n to mend their work while it is going ; this makes all the difference LOCKE AND SYDENHAM. 81 part of physic proceeds, not from a scarcity of medicines to answer particular intentions, but from the want of knowing the intentions to be answered, for an apotheca- ry's apprentice can tell me what medicine will purge, vomit, or sweat, or cool ; but a man must be conversant with practice who is able to tell me when is the proper- est time for administering any of them." He is constantly inculcating the necessity of getting our diagnostic knowledge at first-hand, ridiculing those descriptions of disease which the manufacturers of " Bod- ies of medicine," "Hand-books," and such like, make up in their studies, and which are oftener compositions than portraits, or at the best bad copies, and which the young student will find it hard enough to identify in real life. There is too much of this we fear still ; and Montaigne, who rejoices in having a sly hit at his cro- nies the doctors, might still say with some reason, " Like him who paints the sea, rocks, and heavens, and draws the model of a ship as he sits safe at his table ; but send aim to sea, and he knows not how or where to steer ; so doctors oftentimes make such a description of our maladies as a town-crier does of a lost dog or donkey, of such a color and height, such ears, etc. ; but bring the very animal before him, and he knows it not for all that." Everywhere our author acknowledges the vis medi- catrix naturae, by which alone so many diseases are cured, and without or against which none, and by di- recting and helping which medicine best fulfils its end : " For I do not think it below me or my art to acknowl- edge, with respect to the cure of fevers and other dis- tempers, that when no manifest indication pointed out o me what should be done, I have consulted my pa- 6 82 LOCKE AND SVDENHAJI. tient's safety and my own reputation, most effectually, by doing nothing at all. 1 But it is much to be lamented that abundance of patients are so ignorant as not to know, that it is sometimes as much the part of a skilful physician to do nothing, as at others to apply the most energetic remedies, whence they not only deprive them- selves of fair and honorable treatment, but impute it to ignorance or negligence." We conclude these extracts with a picturesque de- scription. It is a case of " the hysterics " in a man : " I was called not long since to an ingenious gentleman who had recovered from a fever, but a few days before he had employed another physician, who blooded and purged him soundly, and forbade him the use of flesh. When I came I found him up, and heard him talking sensibly. I asked why I was sent for, to which one of his friends replied with a wink, Wait and you '11 see. Accordingly, sitting down and entering into discourse with the patient, I perceived his under lip was thrust outwards, and in frequent motion, as happens to peevish children, who pout before they cry, which was succeeded by the most violent fit of crying, with deep convulsive sobs. I conceived this was occasioned partly by his long illness, partly by the previous evacuations, and partly by emptiness ; I therefore ordered him a roast chicken, and a pint of Canary" Felix ille ! His shrewdness and humor are shown in the story Dr. Paris tells in his Pharmacologia. " This great physician, Sydenham, having long at- tended a gentleman of fortune with little or no advan- tage, frankly avowed his inability to render him any further service, adding at the same time, that there was a physician of the name of Robertson, at Inverness, See note B. LOCKE AND SYDENHAM. 83 *sho had distinguished himself by the performance of many remarkable cures of the same complaint as that under which his patient labored, and expressing a con- viction that, if he applied to him, he would come back cured. This was too encouraging a proposal to be re- jected ; the gentleman received from Sydenham a state- ment of his case, with the necessary letter of introduc- tion, and proceeded without delay to the place iu question. On arriving at Inverness, and anxiously in- quiring for the residence of Dr. Robertson, he found to his utter dismay and disappointment that there was no physician of that name, nor ever had been in the mem- ory of any person there. The gentleman returned, vow- ing eternal hostility to the peace of Sydenham, and on his arrival at home, instantly expressed his indignation at having been sent on a journey of so many hundred miles for no purpose. ' Well,' replies Sydenham, ' are you better in health?' 'Yes, / am now quite well ; but no thanks to you.' ' No,' says Sydenham, ' but you may thank Dr. Robertson for curing you. I wished to send you a journey with some object of interest in view ; I knew it would be of service to you ; in going, you had Dr. Robertson and his wonderful cures in con- templation ; and in returning, you were equally engaged in thinking of scolding me.' " In making these selections we have done our author great injustice, partly from having to give them either in Swan's translation or our own, and thereby losing much of the dignity and nerve the flavor, or what artists would call the crispness of the original ; partly also from our being obliged to exclude strictly profes- sional discussions, in which, as might be expected, his chief value and strength lie. 84 LOCKE AND SYDENHAM We know nothing in medical literature more finished than his letter to Dr. Cole on the hysterical passion, and his monograph of the gout. Well might Edward Hannes, the friend of Addison, in his verses on Syden- ham, thus sing : " Sic te scientem non faciunt libri Et dogma pulchrum ; sed sapientia Enata rebus, mensque facti Experiens, auim usque felix." It would not be easy to over-estimate the permanent impression for good which the writings, the character, and the practice of Sydenham have made on the art of heal- ing in England, and on the Continent generally. In the writings of Boerhaave, Stahl, Gaubius, Piuel, Bordeu, Haller, and many others, he is spoken of as the father of rational medicine ; as the first man who applied to his profession the Baconian principles of interpreting and serving nature, and who never forgot the master's rule, " Non fingendum aut excogitandum, sed inveniendum, quid natura aut faciat aut ferat." He was what Plato would have called an " artsman" as distinguished from a doctor of abstract science. But he was by no means deficient in either the capacity or the relish for specula- tive truth. Like all men of a large practical nature, he could not have been what he was, or done what he did, without possessing and often exercising the true philoso- phizing faculty. Pie was a man of the same quality of mind in this respect with Watt, Franklin, and John Hunter, in whom speculation was not the less genuine that it was with them a means rather than an end. This distinction between the science, and the art or craft, or as it was often called the cunning of medicine, is one we have already insisted upon, and the importance LOCKE AND SYDENHAM. 85 of which we consider very-great, in the present condi- tion of this department of knowledge and practice. We are nowadays in danger of neglecting our art in master- ing our science, though medicine in its ultimate resort must always be more of an art than of a science. It be- ing the object of the student of physic to learn or know some thing or things, in order to be able safely, effectu- ally, and at once, to do some other thing ; and inasmuch as human nature cannot contain more than its fill, a man may not only have in his head much scientific truth which is useless, but it may shut out and hinder and render altogether ineffectual, the active, practical work- manlike faculties, for whose use his knowledge was pri- marily got. It is the remark of a profound thinker, that i( all professional men labor under a great disadvan- tage in not being allowed to be ignorant of what is use- less ; every one fancies that he is bound to receive and transmit whatever is believed to have been known." " It appears to be possible," says Dr. Thomas Young, in his Life of Porson, " that a memory may in itself be even too retentive for real practical utility, as if of too microscopic a nature ; and it seems to be by a wise and benevolent, though by no means an obvious, arrange- ment of a Creative Providence, that a certain degree of oblivion becomes a most useful instrument in the advance- ment of human knowledge, enabling us readily to look back on the prominent features only of various objects and occurrences, and to class them, and reason upon them, by the help of this involuntary kind of abstraction and generalization, with incomparably greater facility than we could do if we retained the whole detail of what had been once but slightly impressed on our minds. It s thus, for example, in physic, that the experienced 83 LOCKE AXD SYDENHAM. practitioner learns at length to despise the relation of individual symptoms and particular cases, on which alone the empiric insists, and to feel the value of the Hippocratic system of ' attending more to the prognos- tic than the diagnostic features of disease;' which, to a younger student, appears to be perfect imbecility." This subject of art and science is hinted at, with his usual sagacity, by Plato, in a singular passage in his Theaetetus: "Particulars," he says, "are infinite, and the higher generalities give no sufficient direction in medicine ; but the pith of all sciences, that which makes the artsman differ from the inexpert, is in the middle prop- ositions, which, in every particular knowledge, are taken from tradition and inexperience." * It would not be easy to convey in fewer words, more of what deserves the name of the philosophy of this entire subject, and few things would be more for the advantage of the best interests of all arts and sciences, and all true progress in human knowledge and power, than the taking this passage and treating it exegetically, as a divine would say, bringing out fully its meaning, and illustrating it by examples. Scientific truth is to the mind of a phy- 1 Being anxious to see what was the context of this remarkable passage, which Bacon quotes, as if verbatim, in his Advancement of Learning, we hunted through the Theaetetus, but in vain. We set two friends, thoroughbred Grecians, upon the scent, but they could find no such passage. One of them then spoke to Sir William Hamilton, and he told him that he had marked that passage as not being a literal translation of any sentence in Plato's writings. He considered it a quotation from memory, and as giving the substance of a passage in the Philebus, which occurs in the 6th and 7th of the forty-two sections of that Dialogue. Perhaps the sentence which comes nearest to the words of Bacon is the last in the 6th section, beginning with the words 01 ift vvv Ttav av9poi. Ta Se fieVa airoGs exfitvyu, of which hd speaks, seem to be equivalent to "the middle propositions." LOCKE AND SYDENHAM. 87 sician what food is to his body ; but, in order to his mhid being nourished and growing by this food, it must be assimilated it must undergo a vital internal change must be transformed, transmuted, and lose its original form. This destruction of former identity this losing of itself in being received into the general mass of truth is necessary in order to bring abstract truth into the condition of what Plato calls " the middle propositions," or, as Mr. Mill calls them, the generalia of knowledge. 1 These are such truths, as have been appropriated, and vitally adopted, by the mind, and which, to use Bacon's strong words, have been " drenched in flesh and blood," have been turned " in succum et sanguinem ; " for man's mind cannot, any more than his body, live on mere ele- mentary substances ; he must have fat, albumen, and sugar ; he can make nothing of their elements, bare car- bon, azote, or hydrogen. And more than this, as we have said, he must digest and disintegrate his food be- 1 The following we give as a sort of abstract of a valuable chapter n Mill's Logic on "The Logic of Art: " An art, or a body of art, "nsists of rules, together with as much of the speculative propositions as comprises the justification of those rules. Art selects and arranges the truths of science in the most convenient order for practice, instead of the order most convenient for thought science following one cause to its various effects, while art traces one effect to its multiplied and diversified causes and conditions. There is need of a set of intermedi- ate scientific truths, derived from the higher generalities of science, and destined to serve as the (jeneralia or first principles of art. The art proposes for itself an end to be gained, defines the end, and hands it over to science. Science receives it, studies it as a phenomenon or effect, and having investigated its causes acd conditions, sends it back to art, \vith a rationale of its cause or causes, but nothing more. Art then examines their combinations, and according as any of them are or are not in human power, or within the scope of its particular end, pro- nounces upon their utility, and forms a rule of action. The rules of art do not attempt to comprise more conditions than require to be at- tended to in ordinary cases, and therefore are always imperfect. 88 LOCKE AND SYDENHAM, fore it can be of any use to him. In this view, as in another and a higher, we may use the sacred words, " That which thou sowest is not quickened except it die; except a corn of wheat fall into the ground and die, it ahideth alone; but if it die, it bringeth forth much fruit ; " for as it is a law of vegetable life, that a seed does not begin to pass into a new form, does not be- gin to grow into a plant, until its own nature is changed, and its original condition is broken up, until it " dies " in giving birth to something better, so is it with scien- tific truth, taken into or planted in the mind, it must die, else it abides alone it does not germinate. Had Plato lived now, he might well have said, "par- ticulars are infinite." Facts, as such, are merely so many units, and are often rather an encumbrance to the practical man than otherwise. These " middle prop- ositions " stand mid-way between the facts in their in- finity and speculative truth in its abstract inertness ; they take from both what they need, and they form a tertium quid, upon which the mind can act practically, and reason upon in practice, and form rules of action. 1 1 Locke thus puts it: "As a help to this, I think it may be pro- posed that, for the saving the long progression of the thoughts to re- mote and first principles in every case, the mind should provide itself several stages; that is to say, intermediate principles, which it might have recourse to in the examining those positions that come in its way. These, though they are not self-evident principles, yet if they have been made out from them by a wary j-ii'l unquestionable deduction, may be depended on as certain and infallible truths, and serve as un- questionable truths to prove other points depending on them by a nearer and shorter view than remote and geueral maxims. These may serve as landmarks to show what lies in the direct way of truth, or is quite besides it. ... Only in other sciences great care is to be taken that they establish those intermediate principles with as much caution, exactness, and indifferency, as mathematicians use in the settling any Df their great theorems. When this is not done but men take up tin LOCKE AND SYDENHAM. 89 * Sydenham, Hippocrates, Abernethy, Pott, Hunter, Bail- lie, Abercrombie, and such like, among physicians, are great in the region of the " middle propositions." They selected their particulars their instances, and they made their higher generalities come down, they appropriated them, and turned them into blood, bone, and sinew. The great problem in the education of young men for the practice of medicine in our times, is to know how to make the infinity of particulars, the prodigious treas- ures of mere science, available for practice how the art may keep pace with, and take the maximum of good out of the science. We have often thought that the ap- prenticeship system is going too much into disrepute. It had its manifest and great evils ; but there was much good got by it that is not to be got in any other way. The personal authority and attachment, the imitation of their master the watching his doings, and picking up the odds and ends of his experience the coming under the influence of his mind, following in his steps, looking with his eyes, and unconsciously accumulating a stock of knowledge, multifarious it might be, the good of which was not fully known till after-years explained and con- firmed its worth. There were other practical things besides jokes learned and executed in the apprentices' room, .and there were the friendships for life, on which so much, not merely of the comfort, but the progress, of a physician depends. Now, everything, at least most, is done in public, in classes ; and it is necessarily with principles in this or that science upon credit, inclination, interest, etc., in haste, without due examination and most unquestionable proof, they lay a trap for themselves, and as much as in them lies captivate their understandings to mistake, falsehood, and error." Of the Con~ duct of the Understanding, pp. 53, 54. London, 1859. 90 LOCKE AND SYDEXHAM. the names of things rather than the things themselves, or their management, that the young men have chiefly to do. The memory 1 is exercised more than the senses or the judgment ; and when the examination comes, as a matter of course the student returns back to his teacher as much as possible of what he has received from him, and as much as possible in his very words. He goes over innumerable names. There is little opportunity even in anatomy for testing his power or his skill as a workman, as an independent observer and judge, under what Sir James Clark justly calls " the demoralizing system of cramming" He repeats what is already known ; he is not able to say how all or any of this knowledge may be turned to practical account. Epictetus cleverly illustrates this very system and its fruits : " As if sheep, 1 Professor Syme, in his Letter to Sir James Graham on the Med- ical Bill, in which, in twelve pages, he puts the whole of this tiresome question on its true footing, makes these weighty observations: "As a teacher of nearly twenty-five years' standing, and well ac- quainted with the dispositions, habits, and powers of medical students, I beg to remark, that the system of repeated examinations on the same subject by different Boards, especially if protracted beyond the age of twenty-two, is greatly opposed to the acquisition of sound and useful knowledge. Medicine, throughout all its departments, is a scieuce of observation; memory alone, however retentive, or diligently assisted by teaching, is unable to afford the qualifications for practice, and it is only by digesting the facts learned, through reflection, com- parison, and personal research, that they can be appropriated with im- proving effect ; but when the mind is loaded with the minuthe of ele- mentary medical and collateral study, it is incapable of the intense and devoted attention essential to attaining any approach to excellence in practical medicine and surgery. It has accordingly always ap- peared to me, that the character of medical men depends less upon what passes during the period even of studentship than upon the mode in which they spend the next years, when, their trials and examina- tions being over the whole strength of a young and disciplined intel lect may be preparing itself for the business of life." LOCKE AND SYDENHAM. 91 after they have been feeding, should present their shep- herds with the very grass itself which they had cropped and stvallowed, to show how much they had eaten, instead of concocting it into wool and milk" Men of the " middle propositions " are not clever, glib expounders of their reasons ; they prefer doing a thing to speaking about it, or how it may be done. We remember hearing a young doctor relate how, on one occasion when a student, he met with the lute Dr. Aber- crombie, when visiting a man who was laboring under what was considered malignant disease of the stomach. He was present when that excellent man first saw the patient along with his regular attendant. The doctor walked into the room in his odd, rapid, indifferent way, which many must recollect ; scrutinized all the curiosities on the mantelpiece ; and then, as if by chance, found himself at his patient's bedside ; but when there his eye settled upon him intensely ; his whole mind was busily at work. He asked a few plain questions ; spoke with great kindness, but briefly ; and coming back to consult, he said, to the astonishment of the surgeon and the young student, " The mischief is all in the brain, the stomach is affected merely through it. The case will do no good ; he will get blind and convulsed, and die." He then, in his considerate, simple way, went over what might be done to palliate suffering and prolong life. He was right. The man died as he said, and on exam- ination the brain was found softened, the stomach sound. The young student, who was intimate with Dr. Aber- crombie, ventured to ask him what it was in the look of the man that made him know at once. "I can't tell you, I can hardly tell myself ; but I rest with confidence upon the exactness and honesty of my past observations. 92 LOCKE AND SYDENHAM. I remember the result, and act upon it ; but I can't put you, or, without infinite trouble, myself, in possession of all the steps." " But would it not be a great saving if you could tell others ? " said the young doctor. " It would be no such thing ; it would be the worst thing that could happen to you ; you would not know how to use it. You must follow in the same road, and you will get as far, and much farther. You must miss often before you hit. You can't tell a man how to hit ; you may tell him what to aim at." " Was it something in the eye ? " said his inveterate querist. " Perhaps it was," he said good-naturedly ; " but don't you go and blister every man's occiput, whose eyes are, as you think, like his." l It would be well for the community, and for the real good of the profession, if the ripe experience, the occa- sional observations of such men as Sydenham and Aber- crombie, formed the main amount of medical books, in- stead of Vade-Mecums, Compendiums, and Systems, on 1 This is very clearly stated by Dr. Mandeville, the acute and no- torious author of the Fable of the Sees, in his dialogues on the Hypo- chondria, one of his best works, as full of good sense and learning as of wit. "If you please to consider that there are no words in any language for an hundredth part of all the minute differences that are obvious to the skilful, you will soon find that a man may know a thing perfectly well, and at the same time not be able to tell you why or how he knows it. The practical knowledge of a physician, or at least the most considerable part of it, is the result of a large collection of obser- vations that have been made on the minutiae of things in human bodies in health and sickness; but likewise there are such changes and differ- ences in these minutiae as no language can express: and when a man has no other reason for what he does than the judgment he has formed from such observations, it is impossible he can give you the one without the other that is, he can never explain his reasons to you, unless h could communicate to you that collection of observations of which hit $kill is the product." LOCKE AND SYDEXHAM. 93 the one hand, and the ardent but unripe lucubrations of very young men. It is said that facts are what we want, and every pe- riodical is filled with papers by very young physicians made up of practical facts. What is fact? we would ask ; and are not many of our new facts little else than the opinions of the writers about certain phenomena, the reality, and assuredly the importance of which, is by no means made out so strongly as the opinions about them are stated? 1 In this intensely scientific age, we need some wise heads to tell us what not to learn or to un- learn, fully as much as what to learn. Let us by all means avail ourselves of the unmatched advantages of modern science, and of the discoveries which every day is multiplying with a rapidity which confounds ; let us convey into, and carry in our heads as much as we safely can, of new knowledge from Chemistry, Statistics, the Microscope, the Stethoscope, and all new helps and methods ; but let us go on with the old serious diligence, the experientia as well as the experimenta the forg- ing and directing, and qualifying the mind as well as the furnishing, informing, and what is called accomplishing it. Let us, in the midst of all the wealth pouring in from without, keep our senses and our understandings well exercised on immediate work. Let us look with our own eyes, and feel with our own fingers. 2 1 Louis, in the preface to the first edition of his Researches on Phthisis, pays "Few persons are free from delusive mental tenden- cies, especially in youth, interfering with true observation ; and I am of opinion that, generally speaking, ice ought to place less reliance on cases collected by very young men ; and, above all, not intrust the task of accumulating facts to them exclusively." 2 We all know Cullen's pithy saying, that there are more false facts than theories in medicine. In his Treatise on the Materia Afedica, which was given to the world when its author was in his seventy- 94 LOCKE AND SYDENHAM. One natural consequence of the predominance in our days of the merely scientific element is, that the elder seventh year, we came upon the full statement of the many mistakes and untruths which are drawii from "false experience." These he iivides into eight classes : 1st, In respect to those supposed remedies, which, from their nature, and their being placed at a distance from the human body, cannot be supposed to have any action upon it. Such are charms, inodorous amulets, sympathetic powders, etc. 2d, Another instance of false experience is with respect to the vir- tues imputed to substances which, when taken into the body, pass through it unchanged, such as mountain crystal, gems, and precious stones, which formerly had a place in our dispensatories. 3d, Whenever to substances obviously inert, or such as have little power of changing the human body, we find considerable effects im- puted. Thus when the excellent Linna-us tells us he preserved him- self from gout by eating every year plentifully of strawberries ! (Here we suspect the Swede was wiser and righter than the Scot.) 4th, tVhen medicines are said to cure what we have no evidence ever existed. As when Dr. Boerhaave says certain medicines correct an atrabilis, a condition he nowhere proves the existence of. The 5lh refers to solvents of the stone taken by the mouth,. to many emmenagogues and diuretics. The Gth, where effects that do really take place are imputed to medi- cines employed, when they are due to the spontaneous operations of the anlni.nl economy, or of nature, as we commonly sjteai ; and he in- stances the vegetables mentioned in the Materia Medica as Vulnera- ries. The 1th and 8th are instances of false experience from mistakes con- cerning tlie real nature of the disease treated, and of the drug em- ployed. It is curious to us who are seventy years older, and it may be wiser (in the main) to note how permanently true much of this still is, and how oddly and significantly illustrative of the very fallacies classified by himself, is the little that is not true. Then follows what we had chiefly in view in this quotation. Dr. Cullen, after stating that these false experiences of writers upon the Materia Medica were mistakes of judgment, and not made under any consciousness of falsehood, reprobates with much severity the manu- facture tf facts in medicine, which have, for reasons of various kinds, been obtruded on the public by persons aware of their being false, or which, at K-ast, they have never proved to be true ; and he ends with this remarkable statement, the moral of which is not peculiar to 1789 . LOCKE AND SYDENHAM. 95 too much serves the younger. The young man teaches and talks, and the old man learns and is mute. 1 This is excellent when it is confined to the statement of dis- covery, or the constantly evolving laws of knowledge, or of matter. But the young men have now almost the whole field to themselves. Chemistry and Physiology have become, to all men above forty, impossible sciences ; they dare not meddle with them ; and they keep back from giving to the profession their own personal experi- ence in matters of practice, from the feeling that much of their science is out of date ; and the consequence is, that, even in matters of pvactice, the young men are in possession of the field. Fruit is pleasantest and every way best when it is ripe ; and practical observations, to be worth anything, must be more of a fruit than a blos- som, and need not be plucked when green. " Plutarch," says old Heberden, " has told us that the life of a vestal virgin was divided into three portions : in the first she learned the duties of her profession, in the second she practised them, and in the third she taught them to others." This he maintained, and we o ' cordially agree with him, was no bad model for the life of a physician, and he followed it himself, as shown by his motto prefixed to his Classical Commentaries, Ftpcov KOL Ka/xi/eiv ov/cm SiW/xet/os, TOVTO TO j3i/3\t.o " This leads me to observe, that a very fertile source of false facts has been opened for some time past. There is in some young phy- sicians the vanity of being the authors of observations, which are often too hastily made, and sometimes perhaps entirely dressed in the -.loset. We dare not at present be too particular, but the next age will discern many instances of perhaps the direct falsehoods, and certainly the many mistakes in fact, produced in the present age concerning the powers and virtues of medicine." Treatise on the Materia Medica, chap. ii. article iv. pp. 142-153. i See Note C. 96 LOCKE AND SYDENHAM. George Jllius may explain to the admiring George pater, the merits and arcana of his Prichett rifle, or his Deane and Adams' revolver, any scientific improve- ment the youngster may teach his " governor," but don't let him go further, and take to giving him instructions in the art of finding and bagging his game. This is ex- actly where we are so apt to go wrong in medicine, as well as in fowling. Let it not be supposed that we despair of Medicine gaining the full benefit of the general advance in knowl- edge and usefulness. Far from it. TVe believe there is more of exact diagnosis, of intelligent, effectual treat- ment of disease, that there are wider views of princi- ples director, ampler methods of discovery, at this moment in Britain than at any former time ; and we have no doubt that the augmentation is still proceeding, and will defy all calculation. But we are likewise of opinion, that the office of a physician, in the highest sense, will become fully more difficult than before, will require a greater compass and energy of mind, as work- ing in a wider field, and using finer weapons ; and that there never was more necessity for making every effort to strengthen and clarify the judgment and tho senses by inward discipline, and by outward exercise, than when the importance and the multitude of the objects of which they must be cognizant are so infinitely increased. The middle propositions must be attended to, and filled up as the particulars and the higher generalities crowd in. It would be out of place in a paper so desultory as the present, to enter at large upon the subjects now hinted at the education of a physician the degree of certainty in medicine its progress and prospects, and the beneficial effects it may reasonably expect from LOCKE AND SYDENHAM. 97 the advance of the purer sciences. But we are not more firmly persuaded of anything than of the importance of such an inquiry, made largely, liberally, and strictly, by a man at once deep, truthful, knowing, and clear. How are we to secure for the art of discerning, curing, and preventing disease, the maximum of good and the min- imum of mischief, in availing ourselves of the newest discoveries in human knowledge ? To any one wishing to look into this most interesting, and at the present time, vital question, we would recom- mend a paper by I^:-. Sellar, admirable equally in sub- stance and in expression, entitled, " On the Signification of Fact in Medicine, and on the hurtful effects of the incautious use of such modern sources of fact as the microscope, the stethoscope, chemical analysis, statistics, etc. ; " it may be found in No. 177 of the Edinburgh Medical and Surgical Journal. We merely give a sam- ple or two, in which our readers will find, in better words, much of what we have already asserted. " Med- icine still is, and must continue for ages to be, an em- pirico-rationalism" " A sober thinker can hardly ven- ture to look forward to such an advanced state of chem- ical rationalism as would be sufficient for pronouncing a priori that sulphur would cure scabies, iodine goitre, citric acid the scurvy, or carbonate of iron neuralgia." " Chemistry promises to be of immediate service in the practice of medicine, not so much by offering us a rational chemical pathology, but by enlarging the sources from which our empirical rules are to be drawn." Here we have our "middle propositions." ''The great bulk of practical medical kuovvledge is obviously the fruit of individual minds, naturally gifted for excellence in medi- cine ; " but the whole paper deserves serious continu- 7 98 LOCKE AND SYDENHAM. ous study. We would also, in spite of some ultraisms in thought and language, the overflowings of a more than ordinarily strong, and ardent, and honest mind, recommend heartily the papers of Dr. Forbes, which appeared at the close of the British and Foreign Medical Review, in which he has, with what we cannot call else or less than magnanimity, spoken so much wholesome, though, it may be, unpalatable truth : and finally, we would send every inquiring student who wishes to know how to think and how to speak on this subject at once with power, clearness, and compactness, and be both witty and wise, to Dr. Latham's little three volumes on Clinical Medicine. The first two lectures in the earliest volume are " lion's marrow," the very pith of sense and sound-mindeflness. We give a morsel " The medical men of England do and will continue to keep pace with the age in which they live, however rapidly ifc may ad- vance. I wish to see physicians still instituted in the same discipline, and still reared in fellowship and com- munion with the wisest and best of men, and that not for the sake of what is ornamental merely, and becoming to their character, but because I am persuaded that that discipline which renders the mind most capacious of wis- dom and most capable of virtue, can hold the torch and light the path to the sublimest discoveries in every sci- ence. It was the same discipline which contributed to form the minds of Newton and of Locke, of Harvey and of Sydenham." He makes the following beautiful remark in leading his pupils into the wards of St. Bartholomew's : "In entering this place, even this vast hospital, where there is many a significant, many a wonderful thing, you shall take me along with you, and I will be your guide. Bui LOCKE AND SYDEXHAM. 99 it is by your own eyes, and your ears and your own minds, and (/ may add) by your own hearts, that you must observe, and learn, and profit. I can only point to the objects, and say little else than ' See here and set there: " This is the great secret, the coming to close quarters with your object, having immediate, not mediate cogni- zance of the materials of study, apprehending first, and then doing your best to comprehend. For, to adapt Bacon's illustration, which no one need ever weary oi giving or receiving, a good practical physician is more akin to the working-bee than to the spider or the ant. Instead of spinning, like the schoolmen of old, endless webs of speculation out of their own bowels, in. which they were themselves afterwards as frequently caught and destroyed as any one else, or hoarding up, grain af- ter grain, the knowledge of other men, and thus becom ing " a very dungeon of learning," in which (ffibernice) they lose at once themselves and their aim they should rather be like the brisk and public-hearted bee, who, by divine instinct, her own industry, and the accuracy oi her instrument, gathers honey from all flowers. " For- mica colligit et utitur, ut faciunt empirici ; aranea ex se fila eclucit ueque a particularibus materiam petit ; apis denique cseteris se mrlius gent, hsec indigesta a floribu* mella colligit, delude in viscerum cellulas concocta ma turat, iisdern tandem insudat donee ad integram perfeq tionem perduxerit." We had intended giving some account of the bear- ing that the general enlightenment of the community has upon Medicine, and especially of the value of the labor? of such men as Dr. Andrew Combe, Dr. Henry Mar shall, Sir James Clark, and others, in the collateral sub 100 LOCKE AND SYDENHAM. jects leading into, and auxiliary to, pure Medicine, but we have no space to do them any measures of justice. The full importance, and the full possibility of the pre- vention of disease in all its manifold, civil, moral, and personal bearings, is not yet by any means adequately acknowledged ; there are few things oftener said, or less icarched into, than that prevention is better than cure. Let not our young and eager doctors be scandalized at our views as to the comparative uncertainty of medi- cine as a science : such has been the opinion of the wis- est and most successful masters of the craft. Radcliffe used to say, that " when young, he had fifty remedies for every disease ; and when old, one remedy for fifty diseases." Dr. James Gregory said, " Young men kill their patients ; old men let them die." Gaubius says, " Equidem candide dicam, plura me indies, dum in artis usu versor, dediscere quam discere, et in crescente aetate, minui potius quam augeri, scientiam," meaning by "sci- entia" an abstract systematic knowledge. And Bordeu gives as the remark of an old physician, " J'etois dogma- tique a vingt aus, observateur a trente, a quarante je f us empirique ; je n'ai point de systeme a cinquante." And he adds, in reference to how far a medical man must personally know the sciences that contributed to his art, " Jphicrates, the Athenian general, was hard pressed by an orator before the people, to say what he was, to be so proud : ' Are you a soldier, a captain, an engi- neer : a spy, a pioneer, a sapper, a miner ? ' ' No,' says Iphicrates, ' I am none of these, but I command them all.' So if one asks me, Are you an empiric, a dogma- tist, an observer, an anatomist, a chemist, a microscopist ? I answer,- No, but I am captain of them all." And to conclude these desultory notes in the opening LOCKE AND SYDEXHAM. 101 words of the Historia Vita et Mortis, " Speramus enim et cupimus futurum, ut id plurimorum bono fiat ; atque ut rnedici nobiliores animos nonnihil erigant, neque toti sint in curarum sordibus, neque solum pro necessitate honorentur, sed fiant demum omnipotentice et dementia divince administri" " Etsi enim," as he pa- thetically adds, " nos Christian! ad terram promissionis perpetuo aspiremus et anhelemus ; tamen interim itine- rantibus nobis, in hac mundi eremo, etiam calceos istos et tegmina (corporis scilicet nostri fragilis) quam mini- mum atteri, erit signuui divini favoris." 1 We have left ourselves no space to notice Pr. Green- hill's collected edition of Sydenham's Latin works. It is everything that the best sholarship, accuracy,, and judgment could make it. We regret we cannot say so much for Dr. R. G. Latham's translation and Life. The first is inferior as a whole to Swan's, and in parts to Pechey's and Wallis's : and the Life, which might have contained so much that is new, valuable, and entertain- ing, is treated with a curious infelicity and clumsiness, that is altogether one of the oddest, most gauche and limping bits of composition we ever remember having met with ; and adds another to the many instances to which Bishop Lowth and Cobbett are exceptions, of a grammarian writing, if not ungrammatically, at least l " For it is our earnest hope and desire, that the efficacy of medi- cine may be infinitely increased, and that physicians may bear them- selves more erect and nobly, and not be wholly taken up with sordid gains and cares, not be honored from necessity alone, but may at length become the executors of Divine omnipotence and mercy ; for though we who are Christians do without ceasing long for, and pant after, the land of promise, we cannot fail to regard it as a token of the favor of God, when, as we travel through this wilderness of the world, these shoes and garments of our frail bodies are rendered, as little as may be, subject to decay." 102 LOCKE AND SYDEXHAM. without elegance, and occasionally without clearness. It is one thing to know, and often quite another to do, the right thing. We cannot close these notices of Sydenham without thanking Dr. Latham for printing in the Appendix to his second volume, the manuscript preserved in the pub- lic library of the University of Cambridge, and referred to in the Biographia Britannica, under Sydenham's name. Dr. Latham states that it is in a more modern handwriting than that of the author's time, and is headed Theologia JRationalis, by Dr. Thomas Sydenham. This is all that is known, but we think it bears strong inter- nal evidence of being authentic. The following note upon it, by a kind friend, 1 who is well able to judge, gives a just estimate of this remarkable relic: " I have looked with much interest over the fragment you point out in Sydeuham's works. I think it is quite misnamed. It should be Ethica Rationalis, or Naturalis, since its avowed aim is not to examine closely the foun- dations of natural theology, but rather ' the question is, how far the light of Nature, if closely adverted to, may be extended toward the making of good men' This question is closely pursued throughout, and leads to the result that there is an order in man's nature, which leads lo a threefold set of obligations, according to the com- jaoh division, towards God, society, and one's-self. This is the plan according to which the fragment is blocked out. The perfections and providence of God are discussed solely as laying a foundation for man's duties ; and these, adoration, prayer, submission, confession of sin are summed up in pages 312, 313. Next fol 1 Rev. John Cairns, D. D. LOCKE AND SYDENHAM. 103 ow the duties to society, very speedily despatched ; and those to self discussed more at length, such as temper- nee, truth, modesty, prudent enjoyment in subservience to reason. With the same ethical aim the question of immortality is discussed, solely as a help to virtue and to the predominance of reason. In arguing this from mmateriality, the author is entangled in the usual diffi- Cilty about the souls of the brutes, but escapes by the Cartesian denial of their true thinking power ; and more satisfactorily by urging the sentimental argument from men's desire of immortality, and the more strictly moral one, from unequal retribution. All this, I think, bears out the view I have taken. There is not, perhaps, so much originality in the views of the author as general soundness and loftiness of moral tone, with that fine power of illustration which you have noticed. I agree with you in seeing much of the spirit both of Locke and Butler : of Locke, in the spirit of observation and geni- ality ; of Butler, in the clear utterances as to the su- premacy of reason, and the necessity of living according to our true nature, not to speak of other agreements in detail. I think the paper well deserves a cordial recog- nition, though it hardly reaches out, perhaps in any one direction, beyond the orthodox ethics of the seventeenth century." We give at random some extracts from the Theologia Rationalis : " Nor indeed can I entertain any thoughts more derogatory from the majesty of this Divine Being, than not supposing him to be a free agent; but having }nce put all his works out of his own hands, to be con- cluded within the limits of his own establishm' hath determined irrational beings to act in some uniform course, suitable to the good of themselves and tho 104 LOCKE AND SYDENHAM. whole. And tho' he hath set up certain lights in intel- lectual natures, wh ch may direct them to pursue ends suitable to their natures, yet having given these a lib- erty of will incident to the very nature of reasonable beings, he retains his power of inclining or not inclin- ing such intellectual natures to pursue courses leading to their welfare." " Also, from the same consideration (the excellence of my mind above my body) it is that I am neither to thinke, speake, or act anything that is indecorous or dis- gracefull to this Divine inmate, whose excellency above my body Nature hath tacitly pointed out, by impressing upon me a verecundia, or being ashamed of many ac- tions of my body, w ch therefore I hide from those of my own species. But now, forasmuch as I consist likewise of a body w ch is submitted to the same conditions with other animals, of being nourished and propagating my kind, and, likewise, w ch wants many other conveniences of clothing, housing, and the like, which their nature re- quires not ; all those likewise are to be respected by me, according to my several wants ; but still with a subser- vience to my reason, which is my superior part, and acts flowing from the same, my chiefest business ; as an em- bassador who is sent into a foreign country, is not sent to eat and to drink, tho' he is enforced to do both." " When I consider that the infinite Governour of the universe hath so made me, that in my intellect I have some small glympses of his being, whilst I cann't but ap- prehend that immensity of power and wisdom w ch is in him, and doth appear in whatsoever I see, and this I must apprehend, even if I endeavour not to do it, it being closely riveted, and as it were co-essential to my nature ; or if I have gotten of it by hearsay onely, it being so LOCKE AND SYDENHAM. 105 fitted to my nature, that I must needs believe it, w ch two make up the same thing. Now how can I think that this Divine Being, that hath admitted me to this little acquaintance w th him, will let the laying down of my body perfectly break off this acquaintance, and not rather that the throwing of this load of corruption will put my soul into a condition more suitable to its own nature, it being much more difficult to think how such a noble substance as the soul should be united to the body, than how it should subsist separately from it. But add to this, that I have not only faculties of knowing this Divine Being, but in complyance with him, I have adored him with all the attention I could screw up my heavy mind unto, and have endeavoured to yield obedi- ence to those lawes w ch he hath written upon my nat- ure ; that I who have done this (supposing that I have done it), should extinguish when my body dies, is yet more unlikely. Moreover I consider that this Maker of the universe hath brought his ends so together, that he hath implanted no affections upon the meanest ani- mal, but hath made objects to answer them ; as he that hath made the eye hath made colours, and he that hath made the organs of hearing hath likewise made sounds, and so of an infinite number of other affections, not only in animals, but even in those natures inferior to them all, w ch have objects suited to them ; and if they had not, there would be a flaw even in the constitution of the universe, w ch can't be charged upon the infinitely wise Creator. But now that there should be found in man- kind a certain appetite or reaching out after a future hap- piness, and that there should be no such thing to answer to it, but that this cheat should be put upon the rational part of man, w ch is the highest nature in the globe where vfQ live, is to me very improbable." 106 LOCKE AND SYDENHAM. We subjoin, with Mr. Black's kind permission, a por- tion pf the Life of Sydenham, iu the last edition of his admirable Encyclopaedia ; it contains, I believe, all the old and some new facts : " SYDENHAM, THOMAS the greatest name in Eng- lish practical medicine was born in 1624 at Winford Eagle, Dorsetshire, where his father, William Syden- ham, had a fine estate. He was a commoner of Mag- dalen Hall, Oxford, 1642, but was obliged to leave that city when it became a royal garrison, not having taken up arms for the king, as the students of those days gen- erally did. In 1649, after the garrison delivered up Oxford to the Parliamentary forces, he returned to Magdalen Hall, and was created Bachelor of Physic on the Pembrokean creation, when Lord Pembroke became Chancellor of the University, and honorary degrees were conferred. This was in April 1648. He had not previously taken any degree in arts. He then, on sub- mitting to the authority of the visitors appointed by the Parliament, was made by them (at the intercession of a relative) Fellow of All Souls, in the room of one of the many ejected Royalists. He continued for some years earnestly prosecuting his profession, and left Oxford without taking any other degree. He was also, accord- ing to his own account, in a letter to Dr. Gould, fellow- commoner of Wadham College in the year Oxford sur- rendered. It is not easy to understand why he went to Wadham, as he was not a fellow but a fellow-commoner equivalent to a gentleman-commoner in Cambridge unless it was that, on returning to Magdalen Hall, he found himself, as a Parliamentarian, more at home in Wadham where the then head was John Wilkins, Cromwell's brother-in-law a man of genius and of a LOCKE AND SYDENHAM. 107 keen scientific spirit, and afterwards and still famous as Bishop of Chester one of the founders of the Royal Society, which first met at Oxford ; and author, among other works, of a discourse on a Universal Language and of an Inquiry as to the best Way of Travelling to the Moon ; a man of rare parts and worth, and of a liberal- ity in religion and science then still rarer, being, accord- ing to Anthony Wood, an " excellent mathematician and experimentist, and one as well seen in the new philoso- phy as any of his time ; such a man would be sure to cordialize with Sydenham, who was of the Baconian or genuine Empiric school ; and who, in the ' new philos- ophy,' saw the day-spring of all true scientific progress. It is not clear when Sydenham settled in London, or more properly speaking in Westminster ; it certainly was before 1661. In 1663 he was admitted a licentiate of the College of Physicians of London, he never was a fellow ; his degree of doctor of medicine was taken at Cambridge in 1676, long after he was in full practice, his college being Pembroke ; his diploma is signed by Isaac Barrow. His reason probably for taking a Cam- bridge degree may have been that his eldest son was a pensioner at that college. " Sydenham's elder brother, William, was a distin- guished soldier and politician during the Commonwealth. This, along with his own likings, and his love of the new philosophy, prevented him during the reigns of the second Charles and James, from enjoying court favour. It has often been doubted whether Sydenham actually served in the army of the Parliament ; but from an anecdote known generally as Dr. Lettsom's, but' which appears first in a curious old controversial book by Dr. Andrew Brown, the Vindicatory Schedule, published 108 LOCKE AND SYDEXH All- two years after Sydenham's death, it is made quite cer- tain that he did. " Before settling in London he seems, on the authority of Desault, to have visited Montpellier, and to have at- tended the lectures of the famous Barbeyrac. After this he devoted himself to his profession, and became the greatest physician of his time, in spite of the court, and of the College of Physicians ; by one of whose fel- lows Lister he was called ' a miserable quack.' He suffered for many of the later years of his life from the gout, his description of which has become classical, and died in his house, Pail-Mall or as he spells it, Pell-Mell in 1689. He lies buried in St. James's, Westminster, with the following noble because trtie in- scription : ' Prope hunc locum sepultus est Tliomas Sydenham, medicus in omne aevum, nobilis, natus erat A. D. 1624: vixit annos 65.' His works, which be- came rapidly popular during his lifetime, and to an extraordinary extent soon after his death there were upwards of twenty-five editions in less than a hundred years consist chiefly of occasional pieces, extorted from him by his friends, and often in the form of let- ters ; none of them are formal treatises, and all are plainly the result of his own immediate reflection and experience. One is greatly struck at the place he oc- cupies in the writings of all the great medical authors at the end of the seventeenth and beginning of the eighteenth centuries. Morton, Willis, Boerhaave, Gau- bius, Bordeu, etc., always speak of him as second in sagacity to ' the divine Hippocrates ' alone. Boerhaave never mentioned him in his class without lifting his hat, and called him Anglice lumen, artis Phoebum, veram Hip- pocratici viri speciem. His simple, manly views of the LOCKE AND SYDENHAM. 109 nature and means of medicine as an art seem to hate come upon the profession like revelations ; it was as if the men in Plato's cavern, who had been all their lives with their backs to the light, studying their own shad- ows, had suddenly turned round and gazed on the broad face of the outer world, lying in sunshine before them. "All Sydenham's works are in Latin, and though from his education and tastes, and the habits of his time, and also from the composition of the Processus Integri brief notes left by him for his sons' use, and published after his death there is little doubt he could have written them in that tongue, there seems every likeli- hood that he was assisted in doing so by his friends Drs Mapletoft and Havers. There are three English trans- lations one by Dr. Pechey, another by Dr. Swan, to which is prefixed a life by Samuel Johnson, among his earliest performances, and published by Cave, and the last, the Sydenham Society's edition, by Dr. Latham." The following hitherto unpublished letters I had the good fortune to find in the British Museum. The first must have been written two months later than the one quoted at page 50, and relsrs to the same subjects : LETTEK FROM JOHN LOCKE TO DR. MAPLETOFT. Paris, 9f Aug. 1677. DEAR SIR, I had noe sooner don my letter on the other side, but I found it answered by yours of July 25, and though it hath satisfied me that you are very well, and given me new proofs that you are very much my friend, yet it hath put new doubts into me, and methinkes I see you going to loose yourself. I will say noe worse of it, not knowing how far the matter is gon, else I would aske you whether the 110 LOCKE AND SYDEXHAM. men, young, old, or middle aged, each of which is sure to meet you with the homes of a dilemma. I see you are, whatever you think, hot upon the scent.; and if you have noething else to defend you, but those maxims you build on, I feare the chase will lead you where yourself will be caught. For be as grave and steady as you please, resolve as much as you will, never to goe out of your way or pace, for never an hey trony nony whatsoever, you are not one jot the safer for all this steadiness. For, believe it, sir, this sorte of game having a designe to be caught, will hunt just at the pursuer's rate, and will goe no further before them than will just serve to make you follow ; and let me assure you upon as good authority as honest Tom Bagnall's that viuus vidcns- que pereo, is the lamentable ditty of many an honest gentle- man. But if you or the Fates (for the poor Fates are still to be accused in the case), if your mettle be up, and as hard as Sir Fr. Drake, you will shoot the desperate gulph ; yet consider that though the riches of Peru lie that way, how will you can endure the warme navigation of the Mare de Zur, which all travellers assure us is nicknamed pacificum. But hold, I goe too far. All this, perhaps, notwithstand- ing your ancient good principles, will be heresie to you by that time it comes to England, and therefore, I conjure you by our friendship to burne this as soon as you have read it, that it may never rise up in judgment against me. I see one is never sure of one's-self, and the time may come when I may resigne myself to the empire of the soft sex, and abominate myself for these miserable errors. How- ever, as the matter now stands, I have discharged my con- science, and pray do not let me suffer-for it. For I know your lovers are a sort of people that are bound to sacrifice everything to your mistresses. But to be serious with you, if your heart does hang that way, I wish you good luck. May Hymen be as kinde to you as ever he was to anybody, and then, I am sure, you will be much happier than any for- lorne batchelor can be. If it be like to be, continue your LOCKE AND SYDENHAM. Ill care of my interest in the case (to get him his chair in Gres ham), and remember it is for one that knows how to value the quiet and retirement you are going to quit. You have no more to do for me than lovers use to doe upon their own account, viz., keepe the matter as secret and private as you can, and then when it is ripe and resolved, give me but no- tice and I shall quickly be with you, for it is by your direc- tions I shall better governe my motives than by the flights of thrushes and fieldfares. Some remains of my cough, and something like a charge is fallen into my hands lately here, will, if noething else happen, keepe me out probably longer than the time you mention. But not knowing whether the aire of France will ever quite remove my old companion or noe, I shall neglect that uncertainty upon the consideration of soe comfortable an importance; and for the other affaire I have here, if you please to let me hear from you sometimes how matters are like to goe, I shall be able to order that enough to come at the time you shall thinke seasonable. Whatever happens, I wish you all the happiness of one or t' other condition. I am perfectly, dear Sir, your most humble and obedient servant. To DK. MAPLETOFT, at Gresliam College. In the same MS. volume in which I found this letter, is a case-book of Locke's in his own neat hand, written in Latin (often slovenly and doggish enough), and which shows, if there were any further need, that he was in active practice in 1667. The title in the Museum yol- ume is " Original Medical Papers by John Locke, pre- sented by Wm. Seward, Esq. ; " and its contents are 1. Hy drops. 2. Rheumatismus. 3. Hydrops. 4. Febris Inflammatoria. 112 LOCKE AND SYDENHAM. To us now it seems curious to think of the author of the Essay on Human Understanding recording all the aches and doses, and minute miseries of an ancilla culi- naria virgo, and to find that after a long and anxious case he was turned 06*, when, as he says, his impatient patient olio advocato medico erumpsit (!) The copy of a Letter of DR. THO. SYDENHAM to DR. GOULD, the original of which was communicated to me by DR. MEAD, Octob. 1, 1743. SIR, I conceive that the Salivation, though raised by Mercury, in your variolous Patient doeth noe more centra- indicate the giving of Paregoricke, than if the same had come on of its own accord in a confluent Pox ; and therefore it will be convenient for you to give him every night such a quieting medicine as this : B Hy Cerasor nigrorum ii, and gut xiiii : Syr de Mecon ^ ss - But if it shall hap- pen, y* the Mercury shall at any time exert its operation by stooles, you may repeat it oftener as there should be occa- sion, after the same manner as it ought to be don. In the first Days of Mercuriall Unctions where when Diarrhoea comes on, there is noe course so proper as to turn the opera- tion of the Mercury upwards, and thereby cause a laudable salivation as y" giving of Laudanum till the Looseness is stopt. As to what you are pleassed to mention concerning success, which yourself and others have had in the trying of ray Processus, I can only say this, that I have bin very careful to write nothing but what was the product of careful obser- vation, soe when the scandall of my person shall be layd aside in my grave, it will appear that I neither suffered my- selfe to be deceived by indulging to idle speculations, nor have deceived others by obtruding anything to them but downright matter of fact. Be pleased to doe me the favour to give my humble service to Mr. Vice- Chancellor your warden, whose father, Bp. of Bristoll, was my intimate LOCKE AND SYDENHAM. 113 friend and countryman. I myself was once a fellow-com- moner of your house (Wadham College, Oxford), but how long since I would be glad to know from you, as I remember it was in the year Oxford surrendered, though I had one of Magdalen Hall some time before. THOMAS SYDENHAM. PELL MELL, Deer. 10, 1667. There is interesting matter in this letter besides its immediate subjects, and some things, I rather think, un- known before of Sydenham's College life. It is the only printed bit of English by its author, except a letter to the Honourable Robert Boyle, quoted in Latham's Life. " The real physician is the one who cures : the obser- vation, which does not teach the art of healing, is not that of a physician, it is that of a naturalist." Brous- sais. NOTE A. P. 45. LORD GRENVILLE. THE reader, we are sure, will not be impatient of the following ex- tracts from Lord Grenville's Tract, entitled Oxford and Locke, already mentioned. It is now rare, and is not likely to be ever reprinted sep- arately. It would not be easy to imagine anything more thoroughly or more exquisitely done than this tract ; it is of itself ample evidence of the accuracy of Lord Brougham's well-known application to its author of Cicero's words : " Erant in eo plurimce literas, nee ece vulgares sed interiores qucedam et reconditce, divina memoria, summa rerborum gravitas et elegantia, atque hcec omnla vitce decorabut diynitas et integ- ritas. Quantum pond us in verbis! Quam nlhil non consideratum, exi- bat ex ore ! Sileamus de illo ni 7ugeamus dolorem." Our extracts are from the First Chapter, " Of Locke's Medical Studies:" 8 114 LOCKE AND SYDENHAM. " In the printed Life of Locke, commonly prefixed to his works, we are told that he applied himself at the university with great diligence to the study of medicine, 'not with any design of practising as a physician, but principally for the benefit of his own constitution, which was but weak.' The self-taught scholar, says the Italian proverb, has an ignorant master; and the patient who prescribes for himself, has not often, I believe, a very wise physician. No such purpose is as- cribed to Locke by Le Clerc, from whom our knowledge of his private history is principally derived. Nor can we believe that such a man chose for himself in youth that large and difficult study, with no view to the good of others, but meaning it to begin and end only with the care of his own health. " From the very first dawn of reviving letters to the present mo- ment, there never has been a period in this country, when the great masters of medicine among us have not made manifest the happy in- fluence of that pursuit on the cultivation of all the other branches of philosophy. And accordingly we find, that while Locke was still proceeding, as it is termed, in the academical course of that noble sci- ence, he was already occupied in laying the foundations of the Essay on the Human Understanding, which, as we learu from Le Clerc, was commenced in 1670. " Mr. Stewart thinks it matter of praise to Locke, that in that work 'not a single passage,' he says, 'occurs, savouring of the Anatomical Theatre, or of the Chemical Laboratory.' This assertion is not to be too literally taken. Certainly no trace of professional pedantry is to be found in that simple and forcible writer. He had looked abroad into all the knowledge of his time, and in his unceasing endeavors to make his propositions and his proofs intelligible and perspicuous to all. he delighted to appeal to every topic of most familiar observation. Among these some reference to medical science could scarcely have been avoided. Nor has it been entirely so. Mr. Stewart himself has elsewhere noticed Locke's 'homely' illustration of the nature of sec- ondary qualities, by the operation of manna on the human body. A more pleasing example of medical allusion is to be found in one of the many passages where Locke points out to us how often men whose opinions substantially agree, are heard wrangling about the names and watchwords of parties and sects, to which they respectively attach quite different significations. He tells us of a meeting of physicians, at which he himself was present. These ingenious and learned men debated long, he says, ' whether any liquor passed through the fila- ments of the nerves,' until it appeared, on mutual explanation, that they all admitted the passage of some fluid and subtle matter through those channels, and had been disputing only whether or not it should LOCKE AND SYDENHAM. 115 be called a liquor, ' which, when considered, they thought not worth contending about.' " In his Letters on Toleration, and in his Essay on the Conduct of the Understanding, his two most valuable, because most practical works, he indulges much more freely in such allusions. It is fre- quently by their aid that, in the first of those admirable productions, he ridicules his unequal adversary's project of enforcing universal con formity by moderate and lenient persecution. In one place he com- pares him to a surgeon using his knife on the sick and sound alike, on bad subjects and on good, without their consent, but, as he assures them, always solely for their own advantage ; and in another place to an empiric, prescribing, says Locke, his ''hiera picra' (HIS HOLT BiTTEits), to be taken in such doses only as shall be sufficient for the cure, without once inquiring in what quantities of that poisonous drug such sufficiency is at all likely to be found. Again, we find him illus- trating in a similar way the proper conduct to be pursued by a mind devoting itself in any case to a genuine search for truth. A diligent and sincere, a close and unbiased examination, he powerfully insists upon as ' the surest and safest ' method for that purpose. Would not this, he asks, be the conduct of a student in medicine wishing to ac- quire just notions of that science, 'or of the doctrines of Hippocrates, or any other book in which he conceived the whole art of physic to be infallibly contained ?' These, and many other passages of a like de- scription, are beauties, surely, not blemishes, in Locke's powerful com- position and certainlv in no decree less valuable, for bearing some tincture of the current in which that great man's thoughts and studies had been so long carried forward." This Hiera Picra still survives under the name of Hickery Pickery; and appears in the London Pharmacopeia of 1650, as thus com- posed : R Cinnamon. Lignum aloes. Asarum root. Spikenard. Mastick. Saffron, aa. 3vj. Aloes (unwashed) 3xijss. Clarified honey, Ibiv. 3 iij. Mix. Ft. elect, sec. art. 116 LOCKE AND SYDEXHAM. NOTE B. P. 82. THE WISDOM OF DOING NOTHING. The reader will mark the coincidence of thought, and even txpres- sion, between Locke and his friend: "I commend very much the discretion of Mrs. Furley, t!-at she would not give him precipitates 1. Because physick is not to be given to children upon every little disorder. 2. Physick for the worms is not to be given upon every bare suspicion that there may be worms. 3. If it were evident that he had worms, such dangerous medicines are not to be given till after the use of other and more gentle and safe remedys. If he continue still dull and melancholy, the best way is to' have him abroad to walke with you every day in the air ; that, I believe, may set him right without any physic, at least if it should not, 't is not fit to give him remedys till one has well examined what is the distemper, unless you think (as is usually doune), that at all hazard something is to be given ; a way, I confess, I could never thinke reasonable, i', being better in my opinion to doe no tkit-j, than to doe amiss." Locke to Furley in Forster. NOTE C. P. 95. THE ELDER SERVING THE YOUNGER. BORDEU puts this Avell, in his candid, lively, and shrewd wny. The whole passage is full of his peculiar humor and sense. Boioeu was in many respects a sort of French Sydenham, like and uiilik*, as a Frenchman is like and unlike an Englishman. He was himi>lf, to use his own phrase, one " des mlance, not merely in principles and rules, and in the point from which they view their relations to their pro- fession, but in more special characteristics of tempera- ment and manner, between him and the illustrious Sy- deuham, and the still more famous "divine old man of Cos." We allude to the continual reference by them to Nature, as a regulating power in the human body ; their avoiding speculations as to essence, and keeping to the consideration of conjunct causes ; their regarding them- selves as the expounders of a law of life, and the inter- preters and ministers of Nature. This one master idea, truly religious in its character, gives to them a steady fervor, a calm persistent enthusiasm or "entheasm" (ti/ and eos), which we regret, for the honor and the good of human nature, is too rare in medical literature, an- cient or modern. The words " Nature," and " the Al- mighty," " the Supreme Disposer," etc., occur in Syden- ham's works as frequently and with the same reference as they do in Dr. Combe's. The following passage from Sydenham, on Nature, will illustrate our meaning : "I here [in the conclusion of his observations on the fever and plague of 1665 and 1666] subjoin a short note, lest my opinion of Nature be taken in a wrong sense. In the foregoing discourse, I have made use of the term Nature, and ascribed vari- ous effects to her, as I would thereby represent some one self-existent being, everywhere diffused throughout 128 DR. ANDREW COMBE. the machine of the universe, which, being endowed with reason, governs and directs all bodies such an one as some philosophers seem to have conceived the soul of the world to be. But I neither affect novelty in my sentiments or expressions ; I have made use of this an- cient word in these pages, if I mistake not, in a qualified sense ; for by Nature I always mean a certain assem- blage of natural causes, which, though destitute of reason and contrivance, are directed in the wisest manner while they perform their operations and produce their effects ; or, in other words, the Supreme Being, by whose power all things are created and preserved, disposes them all in such manner, by his infinite wisdom, that they pro- ceed to their appointed functions with a certain regular- ity and order, performing nothing in vain, but only what is best and fittest for the whole frame of the uni- verse and their own peculiar nature, and so are moved like machines, not by any skill of their own, but by that of the artist." And Hippocrates briefly says, " Nature in man is the aggregate of all things that concur to perfect health, and the foundation of all right reasoning and practice in physic"* exactly the same great truth which Dr. Combe and Sir John Forbes, thousands of years after- wards, are abused by their brethren for proclaiming; and the old Ephesian cry is raised loud and long among the craftsmen, who, like Demetrius and his crew, are less filled with reason than with wrath. As we have already said, Dr. Combe was distin- guished neither as a discoverer nor as a practitioner. Owing to feeble health, he was not permitted the oppor- tunity of being the latter, though he possessed some of i See Note, p. 161. DR. ANDREW COMBE. 129 the highest qualities of a great physician ; and the even- ness of his powers probably would have prevented him from making any one brilliant hit as the former : for it is our notion, for which we have not space here to assign the reasons, that original geniuses in any one depart- ment, are almost always odd 1 that is, are uneven, have some one predominant faculty lording it over the rest. So that, if we look back among the great men in medicine, we would say that Dr. Combe was less like Harvey, or even Sydenharn, than Locke, who, though nj}t generally thought so, was quite as much of a physi- cian during his life, as of a philosopher and politician. It was not merely in their deeper constitutional qualities their love of truth, and of the God of truth their tendency towards what was immediately and mainly use- ful their preferring observation to speculation, but not declining either, as the help and complement of the Other ; their choosing rather to study the mind or body as a totum quid, a unit, active and executive, and as a means to an end, than to dogmatize and dream about its transcendental constitution, or its primary and ultimate condition ; their valuing in themselves, and in others, soundness of mind and body, above mere strength and quickness ; their dislike to learned phrases, and their at- tachment to freedom political, religious, and personal it was not merely in these larger and more substan- tial matters that John Locke and Andrew Combe were 1 " "We usually say that man is a genius, but he has some whims and oddities. Now, in such a case, we would speak more rationally, did we substitute therefore for but. He is a genius, therefore he is whimsical." Dr. John Aitkin. To be sure, it is one thing to have genius, and another to be one, the difference being between possessing, and being possessed by. 9 130 DR. ANDREW COMBE. alike : they had in their outward circumstances and his- tories some curious coincidences. Both were grave, silent, dark-haired, and tall ; both were unmarried, both were much in the company of women of culture, and had much of their best pleasure from their society and sympathy, and each had one of the best of her sex to watch over his declining years, and to close his eyes ; to whose lot it fell, in the tender words of Agricola's stern son-in-law " assidere valetu- dini,fovere deficientem, satiari vul(u, complexu." More- over, both were educated for medicine, but had to relin- quish the active practice of it from infirm health, and in each the local malady was in the lungs. Both, by a sort of accident, came in close contact with men in the highest station, and were their advisers and friends we refer to Lord Shaftesbury, and to the Third William and Leo- pold, two of the wisest and shrewdest of ancient or mod- ern kings. They resided much abroad, and owed, doubt- less, not a little of their largeness of view, and their superiority to prejudice, to having thus seen mankind from many points. Both had to make the art of keeping themselves alive the study of their health a daily matter of serious thought, arrangement, and action. They were singularly free from the foibles and preju- dices of invalids; both were quietly humorous, playful in their natures, and had warm and deep, but not de- monstrative affections ; and to each was given the honor of benefiting their species to a degree, and in a variety of ways, not easily estimated. Locke, though he may be wrong in many of his views of the laws and opera- tions of the human mind, did more than any one man ever did before him, to strengthen and rectify, and re- etore to healthy vigor, the active powers of the mind DR. ANDREW COMBE. 131 observation, reason, and judgment ; and of him, the weighty and choice words of Lord Grenville are literally true : " With Locke commenced the bright era of a new philosophy, which, whatever were still its imperfections, had for its basis clear and determinate conceptions ; free inquiry and unbiassed reason for its instruments, and for its end truth, truth unsophisticated and undisguised, shedding its pure light over every proper object of the human understanding, but confining itself with reveren- tial awe within those bounds which an all-wise Creator has set to our inquiries." While, on the other hand, Dr. Combe, making the body of man his chief study, did for it what Locke did for the mind : he explained the laws of physiology, rather than the structure of the organs ; he was more bent upon mastering the dynamics than the statics of health and disease ; but we are too near his time, too imperfectly aware of what he has done for us, to be able to appreciate the full measure or quality of the benefit he has bestowed upon us and our posterity, by his simply reducing man to himself bringing him back to the knowledge, the acknowledgment, and the obedience of the laws of his nature. Dr. Combe's best-known publications are, his Princi- ples of Physiology applied to Health and Education, his Physiology of Digestion, and his Treatise on the Physio- logical and Moral Management of Infancy. The first was the earliest, and is still the best exposition and ap- plication of the laws of health. His Digestion is perhaps the most original of the three. It is not so much taken up as such treatises, however excellent, generally are with what to eat and what not to eat, as with how to eat anything and avoid nothing, how so to regulate the great ruling powers of the body, as to make the stomach 132 DR. ANDREW COMBE. do its duty upon whatever that is edible is submitted to it. His book on the Management of Infancy is to us the most delightful of all his works : it has the simplicity and mild strength, the richness and vital nutriment of " the sincere milk " that first and best-cooked food of man. This lactea ubertas pervades the whole little vol- ume ; and we know of none of Dr. Combe's books in which the references to a superintending Providence, to a Divine Father, to a present Deity, to be loved, hon- ored, and obeyed, are so natural, so impressive, so nu- merous, and so child-like. His Observations on Mental Derangement have long been out of print. We sincerely trust that Dr. James Coxe, who has so well edited the last edition of his uncle's Physiology, may soon give us a new one of this important work, which carries his princi- ples into an important region of human suffering. Apart altogether from its peculiar interest as an application of Phrenology to the knowledge and cure of Insanity it is, as Dr. Abercrombie, who was not lavish of his praise, said, "full of sound observation and accurate thinking, and likely to be very useful." There is, by the by, one of Dr. Combe's papers, not mentioned by his brother, which we remember reading with great satisfaction and profit, and which shows how he carried his common sense, and his desire to be useful, into the minutest arrangements. It appears in Cham- bers's Journal for August 30, 1834, and is entitled, " Sending for the Doctor ; " we hope to see the nine rules therein laid down, in the next edition of the Life. We shall now conclude this curious survey of Dr. Combe's relations, general and direct, to medicine, by earnestly recommending the study of his Memoirs to all medical men, young and old, but especially the young DR. ANDREW COMBE. 133 They will get not merely much instruction of a general kind, from the contemplation of a character of singular worth, beauty, and usefulness, but they will find lessons everywhere, in their own profession, lessons in doctrine and in personal conduct ; and they will find the entire history of a patient's life and death, given with a rare fulness, accuracy, and impressiveness ; they will get hints incidentally of how he managed the homeliest and most delicate matters ; how, with order, honesty, and an ar- dent desire to do good, he accomplished so much, against and in spite of so much. We would, in fine, recommend his letter to Sir James Clark on the impor- tance of Hygiene as a branch of medical education (p. 311) ; his letter to the same friend on medical education (p. 341), in regard to which we agree with Sir James, that the medical student cannot have a better guide dur- ing the progress of his studies ; a letter on the state of medical science (p. 400) ; his remarks on the qualifica- tions for the superintendent of a lunatic asylum ; and, at p. 468, on scepticism on the subject of medical sci- ence. These, and his three admirable letters to Dr. Forbes, would make a choice little book. We conclude with a few extracts taken from these papers at random. It would be difficult to put more truth on their subjects into better words. " I have always attached much less importance than is usually done, to the abstract possibility or impossibil- ity of finishing the compulsory part of professional edu- cation, within a given time, and have long thought that more harm than good has been done by fixing too early a limit. The intelligent exercise of medicine requires not only a greater extent of scientific, and general attain- ments, but also readier comprehensiveness of mind, and 134 DR. ANDREW COMBE. greater accuracy of thinking and maturity of judgment, than perhaps any other profession ; and these are quali- ties rarely to be met with in early youth. So generally is this felt to be the case, that it is an all but universal practice for those who are really devoted to the profes- sion, to continue their studies for two or three years, or even more, after having gone through the prescribed curriculum, and obtained their diplomas ; and those only follow a different course who are pressed by necessity to encounter the responsibilities of practice, whether satis- fied or not with their own qualifications ; and if this be the case, does it not amount to a virtual recognition, that the period now assigned by the curriculum is too short, and ought to be extended ? In point of fact, this latter period of study is felt by all to be by far the most instructive of the whole, because now the mind is com- paratively matured, and able to draw its own inferences from the facts and observations of which it could before make little or no use ; and it is precisely those who en- ter upon practice too early who are most apt to become routine practitioners, and to do the least for the advance- ment of medicine as a science." P. 343. " The only thing of which I doubt the propriety is, requiring the study of logic and moral philosophy at so early an age. For though a young man before eighteen may easily acquire a sufficient acquaintance with one or two books on these subjects, such as Whately and Paley, to be able to answer questions readily, I am quite con- vinced that his doing so will be the result merely of an intellectual effort in which memory will be exercised much more than judgment, and that the subjects will not become really useful to him like those which he feels and thoroughly understands, but will slip from him the DR. ANDREW COMBE. 13 moment his examination is at an end, and probably leave a distaste for them ever after. To logic, so far as connected with the structure of language, there can be no objection at that age ; but as an abstract branch of science, I regard it, in its proper development, as fit only for a more advanced period of life. The whole basis and superstructure of moral philosophy, too, imply for their appreciation a practical knowledge of human na- ture, and of man's position in society, of his proper aims and duties, and of his political situation, which it is impossible for a mere youth to possess ; and, in the ab- sence of acquaintance with, and interest in the real sub- jects, to train the mind to the use of words and phrases descriptive of them (but, to him, without correct mean- ing) is likely to be more injurious than beneficial. A man must have seen and felt some of the perplexities of his destiny, and begun to reflect upon them in his own mind, before he can take an intelligent interest in their discussion. To reason about them sooner, is like reason- ing without data ; and besides, as the powers of reflec- tion are always the latest in arriving at maturity, we may fairly infer that Nature meant the knowledge and experience to come first." P. 348. Sir William Hamilton, who differs so widely from Dr. Combe in much, agrees with him in this, as may be seen from the following note in his edition of Reid, p. 420. 1 1 As a corollary of this truth ("Reflection does not appear in chil- dren. Of all the powers of the mind, it seems to be of the latest growth, whereas consciousness is coeval with the earliest"), Mr. Stewart makes the following observations, in which he is supported bv every competent authority in education. The two northern uni- versities ba" long withdrawn themselves from the reproach of plac- ing Physic" last in their curriculum of arts. In that of Edinburgh, 136 DR. ANDREW COMBE. " If there is one fault greater than another, and one source of error more prolific than another, in medical investigations, it is the absence of a consistent and phil- osophic mode of proceeding ; and no greater boon could be conferred upon medicine, as a science, than to render its cultivators familiar with the laws or principles by which inquiry ought to be directed. I therefore regard what I should term a system of Medical Logic as of inestimable value in the education of the practitioner ; but I think that the proper time for it would be after the student had acquired a competent extent of knowl- edge, and a certain maturity of mind." P. 350. " The one great object ought to be the due qualifica- no order is prescribed ; but in St. Andrews and Glasgow, the % class of Physics still stands after those of mental philosophy. This absurdity is, it is to be observed, altogether of a modern introduction. For, when our Scottish universities were founded, and long after, the phi- losophy of mind was taught by the professor of physics. " I appre- hend," says Mr. Stewart, " that the study of the mind should form the last branch of the education of youth; an order which Nature her- self seems to point out, by what I have already remarked with respect to the development of our faculties. After the understanding is well stored with particular facts, and has been conversant with particular scientific pursuits, it will be enabled to speculate concerning its own powers with additional advantage, and will run no hazard in indulg- ing too far in such inquiries. Nothing can be more absurd, on this as well as on many other accounts, than the common practice which is followed in our universities [in some only], of beginning a course of philosophical education with the study of logic. If this order were completely reversed ; and if the study of logic were delayed till after the mind of the student was well stored with particular facts in phys- ics, in chemistry, in natural and civil history, his attention might be led with the most important advantage, and without any danger to his power of observation, to an examination of his own faculties, which, besides opening to him a new and pleasing field of speculation would enable him to form an estimate of his own powers, of the acqui- sitions he has made, of the habits he has formed, and of the f urthe- improvements of which his mind is susceptible." H. DR. ANDREW COMBE. 137 tion of the practitioner ; and whatever will contribute to that end ought to be retained, whether it may happen to agree with or differ from the curricula of other uni- O versities or licensing bodies. Ttie sooner one uniform system of education and equality of privileges prevails throughout the kingdom, the better for all parties." P. 359. " The longer I live, the more I am convinced that medical education is too limited and too hurried, rather than too extended ; for, after all, four years is but a short time for a mind still immature to be occupied in master- ing and digesting so many subjects and so many details. Instead of the curriculum being curtailed, however, I feel assured that ultimately the period of study will be extended. Supposing a young man to be engaged in the acquisition of knowledge and experience till the age of twenty-three instead of twenty-one, can it be said that he will then be too old for entering upon independ- ent practice ? or that his mind is even then fully ma- tured, or his stock of knowledge such as to inspire full confidence ? It is in vain to say that young men will not enter the profession if these additions are made. The result would inevitably be to attract a higher class of minds, and to raise the character of the whole pro- fession." P. 360. " The bane of medicine and of medical education at present is its partial and limited scope. Branches of knowledge, valuable in themselves, are studied almost always separately, and without relation to their general bearing upon the one grand object of the medical art, viz., the healthy working or restoration of the whole bodily and mental functions. We have abundance of tourses of lectures on all sorts of subjects, but are no- 138 DR. ANDREW COMBE. where taught to group their results into practical masses or principles. The higher faculties of the professional mind are thus left in a great measure unexercised. The limited and exclusive knowledge of the observing powers is alone sought after, and an irrational experience is substituted for that which alone is safe, because com- prehensive and true in spirit. The mind thus exercised within narrow limits, becomes narrowed and occvpied with small things. Small feelings follow, and the natural result is that place in public estimation which narrow- mindedness and cleverness in small things deserves. The profession seeks to put down quacks, to obtain medical reform by Act of Parliament, and to acquire public in- fluence ; and a spirit is now active which will bring forth good fruit in due time. An Act of Parliament can remedy many absurdities connected with the privileges of old colleges and corporations, and greatly facilitate improvement ; but the grand reform must come from within, and requires no Act to legalize its appearance. Let the profession cultivate their art in a liberal and comprehensive spirit, and give evidence of the predomi- nance of the scientific over the trade-like feeling, and the public will no longer withhold their respect or deny their influence." P. 400. " If you ask. Why did not God effect his aim with- out inflicting pain or suffering on any of us? that just opens up the question, Why did God see fit to make man, man, and not an angel ? I can see why a watch- maker makes a watch here and a clock there, because my faculties and nature are on a par with the watch- maker's ; but to understand why God made man what he is, I must have the faculties and comprehension of the Divine Being; or, in other words, the creature must DR. ANDREW COMBE. 139 be the equal of the Creator in intellect before he can understand the cause of his own original formation. Into that, therefore, I am quite contented not to in- quire." P. 403. " I should say that the province of Hygiene is to ex- amine the relations existing between the human consti- tution on the one hand, and the various external objects or influences by which it is surrounded on the other; and to deduce, from that examination, the principles or rules by which the highest health and efficiency of all our functions, moral, intellectual, and corporeal, may be most certainly secured, and by obedience to which we may, when once diseased, most speedily and safely regain our health. But perhaps the true nature of Hy- giene will be best exhibited by contrasting what at pres- ent is taught, with what we require at the bedside of the patient, and yet are left to pick up at random in the best way we can." P. 312 " Hygi ene > according to my view, really forms the connecting link by which '1.1 the branches of profes- sional knowledge are bovnd together, and rendered available in promoting human health and happiness ; and, in one sense, is consequently the most important subject for a course of lectures, although very oddly almost the only one which has not been taught syste- matically ; and I consider the absence of the connecting principle as the main cause why medicine has advanced so slowly, and still assumes so little of the aspect of a certain science, notwithstanding all the talent, time, and labor devoted to its cultivation." P. 319. 140 DR. ANDREW COMBE. NOTE. P. 128. VIS MEDICATRIX NATUR.S. DR. ADAMS, in his Preliminary Discourse to the Sydenham Socie- ty's Edition of the Genuine Works of Hippocrates, translated aud an- notated by him a work, as full of the best common sense and judg- ment, as it is of the best learning and scholarship has the following passage : 41 Above all others, Hippocrates was strictly the physician of experi- ence and common sense. In short, the basis of his system was a rational experience, and not a blind empiricism, so that the Empirics in after ages had no good grounds for claiming him as belonging to their sect. 44 One of the most distinguishing characteristics, then, of the Hippo- cratic system of medicine, is the importance attached in it to prognosis, under which was comprehended a complete acquaintance with the previous and present condition of the patient, and the tendency of the disease. To the overstrained system of Diagnosis practised in the school of Cnidos, agreeably to which diseases were divided and sub- divided arbitrarily into endless varieties, Hippocrates was decidedly opposed; his own strong sense and high intellectual cultivation hav- ing, no doubt, led him to the discovery, that to accidental varieties of diseased action there is no limit, and that what is indefinite cannot be reduced to science. 44 Nothing strikes one as a stronger proof of his nobility of soul, when we take into account the early period in human cultivation at which he lived, and his descent from a priestly order, than the contempt which he everywhere expresses for ostentatious charlatanry, and his perfect freedom from all popular superstition. 1 Of amulets and com- 1 " This is the more remarkable, as it does not appear to have been the es- tablished creed of the greatest literary men and philosophers of the age, who still adhered, or professed to adhere, to the popular belief ia the extraordi- nary interference of the gods with the works of Nature and the affairs of mankind. This, at least, was remarkably the case with Socrates, w'n-ise mind, like that of most men who make a great impression on the religious feelings of their age, had evidently a deep tinge of mysticism. See Xenoph Mentor, i. 1. 6-9 ; Ibid. iv. 7. 7 ; also Crete's History of Greece, vol. i. p. 499 The latter remarks, ' Physical and astronomical phenomena are classified by Socrates among the divine class, interdicted to human study.' (Mem. i 1. 13.) lie adds, in reference to llippocrates, ' On the other hand, Uippoc- rates, the contemporary of Socrates, denied the discrepancy, and merged DR. ANDREW COMBE. 141 plicated machines to impose on the credulity of the ignorant multitude, there is no mention in any part of his works. All diseases he traces to natural causes, and counts it impiety to maintain that any one more than another is an infliction from the Divinity. How strikingly the Hippocratic system differs from that of all other nations in their in- fantine state, must be well known to every person who is well acquainted with the early history of medicine. His theory of medi- cine was further based on the physical philosophy of the ancients, more especially on the doctrines then held regarding the elements of things, and the belief in the existence of a spiritual essence diffused through the whole works of creation, which was regarded as the agent that presides over the acts of generation, and which constantly strives to preserve all things in their natural state, and to restore them when they are preternatural ly deranged. This is the principle which he called Nature, and which he held to be a vis medicatrix. 'Nature,' says he, or at least one of his immediate followers says, ' is the phy- sician of diseases.' " STAHL, in one of his numerous short occasional Tracts, Schediasmata, as he calls them, in which his deep and fiery nature was constantly finding vent, thus opens on the doctrine of "Nature," as held by the ancients. Besides the thought, it is a good specimen of this great man's abrupt, impetuous, pregnant, and difficult expressions : " Notanter Hippocrates 6. Kpidem. 5. 'An-ou'SevTo? 17 vcris eoCcra Kai oil naOova-a, TO. SeovTa rroieei. Cum a nullo informata sit NATURA, neque quicquam didicerit, ea tamen quibus opus est, efficit. Ejficere et ope- rari, dicit ; neque incongrua et aliena, sed qua? necessaria sint, quae conveniant: Operari autem ipsam per se, non ex consilio (intellige, alieno) lin. prseced. monet. Effeclivum hoc & operalivum Principium, ri)v alnov circumscribit Galen, de Placit. Hipp, (f Platon. 1. 9. hunc eundem locum attingens. De hac Natura prolixius idem Galenus lib. de Natur. facult. asserit, quod ilia, suis viribus usa, quce noxia sunt, expellere noverit, quce utilia, usui servare. Quod idem et lib. i. crip. s. de diff. Febb. repetit. Snpien- tissimam ipsam esse, itidem adstruit lib. de arte. Et omnia facere talutis hominum causa, in Comm. ad nostrum locum interpretatur. Ne- que hoc tantum de statu Corporis Humani tranquillo, et sibi constante, intelligendum, sed monent etiam iidem, Naturam hactenus dictam, consulere corpori in dubiis rebus, ingruente nocumentorum periculo, into one the two classes of phenomena the divine and the scientifically de- terminable which the latter had put asunder. Hippocrates treated all phe- nomena as at once both, divine and scientifically delcrminable. 1 " 142 DR. ANDREW COMBE. imo actuales, noxa-s illatas, ita depellere, corrigere, cxterminare, resar- cire, ut propterea Hippocrates, paulo antksententiam hactenus citatam, diserte affirmet, Naturam mederi morlis. In quam ipsam assertionein, ut satis fuse consentit Galenas, ita notabilia sunt ejus verba, quod Na~ tura malum sentlens, gestiat maynopere mederi. Et Corn. Celsus, lib. 3. c. i. Repugnante Natura, ait, nihil proficit Mediclna. lino nee deficitnte eadem, ut Hipp. lib. de arte monet, quicquam obtinet Med- ico, ars, sed peril ceyer. Dies deficiat, neque hsec charta capiat, si plerosque tantum, qui comparent, testes Medicos Practices scriptores, citare liberet. Nimirum QUOD tale Activum et Effectivum, Gubernans, dirigens, re yens, Principium in Corpore Vivo praesto sit, tarn in statu sano quam concusso, ayens, vigilans, propugnans, onines agnoscunt. " Ut undique NATURA, hoc sensu, ut Effectivum quoddam, et qui- dem (cupi'ws tale, Principium asseratur, quod, arbitrarie, agere non agere, recte aut perperam Organa sua actuare, iisque non magis uti, quam abuti queat. " Adornarunt hanc Doctrinae Medicse partem complures, turn Anti- quiores, tiim propiorum temporum Doctores, sed nou eodein omnes suc- cessu, nee fort6 eadem intentione. Prolixiores fuerunt Veteres, in illia S vdneo-iv, a's SioKixelrai TO v